慢性冠状动脉疾病初始侵入策略的衰弱、负担和疗效:缺血试验。

IF 4.5 2区 医学 Q1 GERIATRICS & GERONTOLOGY
Lajjaben Patel, Matthew W. Segar, Muhammad S. Usman, Ritika Dhruve, Neil Keshvani, Alexander Postalian, Amgad Mentias, Craig D. Rubin, Kershaw V. Patel, Dharam J. Kumbhani, Subhash Banerjee, Ambarish Pandey
{"title":"慢性冠状动脉疾病初始侵入策略的衰弱、负担和疗效:缺血试验。","authors":"Lajjaben Patel,&nbsp;Matthew W. Segar,&nbsp;Muhammad S. Usman,&nbsp;Ritika Dhruve,&nbsp;Neil Keshvani,&nbsp;Alexander Postalian,&nbsp;Amgad Mentias,&nbsp;Craig D. Rubin,&nbsp;Kershaw V. Patel,&nbsp;Dharam J. Kumbhani,&nbsp;Subhash Banerjee,&nbsp;Ambarish Pandey","doi":"10.1111/jgs.19508","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Frailty is common among patients with chronic coronary disease and is associated with worse outcomes.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A pooled, post hoc analysis of the ISCHEMIA and ISCHEMIA-CKD trials was conducted. Baseline frailty was assessed using a Frailty Index (FI), and participants were categorized into data-derived tertiles. Multivariable Cox models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether baseline frailty status modified the treatment effect of the initial invasive (vs conservative) strategy on a composite outcome of cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest and the secondary outcome of HRQoL (Seattle Angina Questionnaire [SAQ]).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 5322 participants (mean 64 years, 24% female), a high frailty burden (tertile 3 vs. tertile 1) was associated with lower baseline SAQ scores and increased risk of adverse clinical outcomes on follow-up. Baseline frailty burden did not significantly modify the effect of the initial invasive strategy on the primary composite outcome (<i>P</i>\n <sub>interaction</sub>frailty × intervention arm = 0.30). However, frailty significantly modified the effect of the initial invasive strategy on HRQoL, with higher baseline frailty burden associated with greater improvement in SAQ scores at 1 year with initial invasive (vs. conservative) treatment (<i>P</i>\n <sub>interaction</sub>frailty × intervention arm &lt; 0.001). The treatment effect of an initial invasive vs. conservative strategy on 12-month SAQ score change was most pronounced in individuals with lower baseline SAQ scores in both higher and lower frailty burden groups.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Patients with chronic coronary disease with a higher frailty burden are more likely to experience greater improvements in HRQoL with initial invasive management without a higher risk of adverse clinical events. Lower baseline SAQ scores predicted greater improvement in HRQoL with initial invasive management, independent of frailty burden.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2376-2385"},"PeriodicalIF":4.5000,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials\",\"authors\":\"Lajjaben Patel,&nbsp;Matthew W. Segar,&nbsp;Muhammad S. Usman,&nbsp;Ritika Dhruve,&nbsp;Neil Keshvani,&nbsp;Alexander Postalian,&nbsp;Amgad Mentias,&nbsp;Craig D. Rubin,&nbsp;Kershaw V. Patel,&nbsp;Dharam J. Kumbhani,&nbsp;Subhash Banerjee,&nbsp;Ambarish Pandey\",\"doi\":\"10.1111/jgs.19508\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Frailty is common among patients with chronic coronary disease and is associated with worse outcomes.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A pooled, post hoc analysis of the ISCHEMIA and ISCHEMIA-CKD trials was conducted. Baseline frailty was assessed using a Frailty Index (FI), and participants were categorized into data-derived tertiles. Multivariable Cox models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether baseline frailty status modified the treatment effect of the initial invasive (vs conservative) strategy on a composite outcome of cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest and the secondary outcome of HRQoL (Seattle Angina Questionnaire [SAQ]).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Among 5322 participants (mean 64 years, 24% female), a high frailty burden (tertile 3 vs. tertile 1) was associated with lower baseline SAQ scores and increased risk of adverse clinical outcomes on follow-up. Baseline frailty burden did not significantly modify the effect of the initial invasive strategy on the primary composite outcome (<i>P</i>\\n <sub>interaction</sub>frailty × intervention arm = 0.30). However, frailty significantly modified the effect of the initial invasive strategy on HRQoL, with higher baseline frailty burden associated with greater improvement in SAQ scores at 1 year with initial invasive (vs. conservative) treatment (<i>P</i>\\n <sub>interaction</sub>frailty × intervention arm &lt; 0.001). The treatment effect of an initial invasive vs. conservative strategy on 12-month SAQ score change was most pronounced in individuals with lower baseline SAQ scores in both higher and lower frailty burden groups.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Patients with chronic coronary disease with a higher frailty burden are more likely to experience greater improvements in HRQoL with initial invasive management without a higher risk of adverse clinical events. Lower baseline SAQ scores predicted greater improvement in HRQoL with initial invasive management, independent of frailty burden.</p>\\n </section>\\n </div>\",\"PeriodicalId\":17240,\"journal\":{\"name\":\"Journal of the American Geriatrics Society\",\"volume\":\"73 8\",\"pages\":\"2376-2385\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-05-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Geriatrics Society\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.19508\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Geriatrics Society","FirstCategoryId":"3","ListUrlMain":"https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.19508","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

背景:虚弱在慢性冠状动脉疾病患者中很常见,并且与较差的预后相关。方法:对缺血和缺血- ckd试验进行汇总、事后分析。基线虚弱使用虚弱指数(FI)进行评估,参与者被分类为数据派生的分类。构建具有多重相互作用项(虚弱×治疗组)的多变量Cox模型,以评估基线虚弱状态是否改变了初始侵入(与保守)策略对心血管死亡、心肌梗死、不稳定心绞痛住院、心力衰竭或复苏性心脏骤停的复合结局和HRQoL的次要结局的治疗效果(西雅图心绞痛问卷[SAQ])。结果:在5322名参与者(平均64岁,24%女性)中,高虚弱负担(3对1)与较低的基线SAQ评分和随访时不良临床结果的风险增加相关。基线虚弱负担并没有显著改变初始侵入策略对主要综合结局的影响(pinteraction羸弱×干预组= 0.30)。然而,虚弱显著改变了初始侵入策略对HRQoL的影响,初始侵入治疗(与保守治疗相比)1年时,更高的基线虚弱负担与更大的SAQ评分改善相关(pinteraction羸弱×干预组)。具有较高虚弱负担的慢性冠状动脉疾病患者更有可能通过初始侵入性治疗获得更大的HRQoL改善,而没有较高的不良临床事件风险。较低的基线SAQ评分预示着初始侵入性治疗后HRQoL的改善更大,与虚弱负担无关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials

Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials

Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials

Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials

Background

Frailty is common among patients with chronic coronary disease and is associated with worse outcomes.

Methods

A pooled, post hoc analysis of the ISCHEMIA and ISCHEMIA-CKD trials was conducted. Baseline frailty was assessed using a Frailty Index (FI), and participants were categorized into data-derived tertiles. Multivariable Cox models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether baseline frailty status modified the treatment effect of the initial invasive (vs conservative) strategy on a composite outcome of cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest and the secondary outcome of HRQoL (Seattle Angina Questionnaire [SAQ]).

Results

Among 5322 participants (mean 64 years, 24% female), a high frailty burden (tertile 3 vs. tertile 1) was associated with lower baseline SAQ scores and increased risk of adverse clinical outcomes on follow-up. Baseline frailty burden did not significantly modify the effect of the initial invasive strategy on the primary composite outcome (P interactionfrailty × intervention arm = 0.30). However, frailty significantly modified the effect of the initial invasive strategy on HRQoL, with higher baseline frailty burden associated with greater improvement in SAQ scores at 1 year with initial invasive (vs. conservative) treatment (P interactionfrailty × intervention arm < 0.001). The treatment effect of an initial invasive vs. conservative strategy on 12-month SAQ score change was most pronounced in individuals with lower baseline SAQ scores in both higher and lower frailty burden groups.

Conclusion

Patients with chronic coronary disease with a higher frailty burden are more likely to experience greater improvements in HRQoL with initial invasive management without a higher risk of adverse clinical events. Lower baseline SAQ scores predicted greater improvement in HRQoL with initial invasive management, independent of frailty burden.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
10.00
自引率
6.30%
发文量
504
审稿时长
3-6 weeks
期刊介绍: Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信