Major Bleeding Up With Frailty in Acute MI Patients
TUESDAY, Nov. 20, 2018 -- Frail acute myocardial infarction (AMI) patients are less likely to undergo cardiac catheterization and have an increased risk for bleeding, according to a study published in the Nov. 26 issue of JACC: Cardiovascular Interventions.
John A. Dodson, M.D., M.P.H., from NYU Langone Health in New York City, and colleagues examined frailty among 129,330 AMI patients aged ≥65 years. Frailty was classified based on impairment in walking, cognition, and activities of daily living. Impairment was scored in each domain, and a summary variable consisting of three categories was created.
The researchers found that 16.4 percent of patients had any frailty. Frail patients were less likely to undergo cardiac catheterization. There was an increase in major bleeding across categories of frailty (fit/well, 6.5 percent; vulnerable/mild frailty, 9.4 percent; and moderate-to-severe frailty, 9.9 percent; P < 0.001). Compared with the nonfrail group, both frailty categories were independently associated with bleeding risk among patients who underwent catheterization (vulnerable/mild frailty: adjusted odds ratio, 1.33; 95 percent confidence interval, 1.23 to 1.44; moderate-to-severe frailty: adjusted odds ratio, 1.4; 95 percent confidence interval, 1.24 to 1.58). Frailty was not associated with bleeding among patients managed conservatively (vulnerable/mild frailty: adjusted odds ratio, 1.01; 95 percent confidence interval, 0.86 to 1.19; moderate-to-severe frailty: adjusted odds ratio, 0.96; 95 percent confidence interval, 0.81 to 1.14).
"These findings highlight the conundrum with invasive management strategies in frail AMI patients," the authors write.
Two authors disclosed financial ties to the pharmaceutical and medical device industries.
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Posted: November 2018