Impact of frailty on hospital adverse outcomes in elderly admitted with acute coronary syndrome

BACKGROUND: Frailty represents a complex clinical syndrome of decreased physiological reserve and increased vulnerability to stressors. Little is known regarding interaction between frailty status and outcomes in patients with acute coronary syndrome. Our study aims to assess the prevalence of frailty and its impact on in-hospital adverse outcomes of patients aged ≥ 75 years admitted for acute coronary syndromes. METHODS: In this retrospective, single centre, observational study were included patients aged ≥ 75 years admitted for acute coronary syndromes between January 2011 and December 2015. Frailty was assessed using the Fried criteria. The primary endpoint was all-cause in-hospital mortality. Secondary endpoints included the occurrence of re-infarction, stroke and major bleeding. RESULTS: Of the 502 patients included, 126 were classified as frail. These patients were older (mean age 78±5.5 vs. 76.2±5.5 years; p = 0.020), more often male (68.3%) and had a higher risk profile according to GRACE (151.4±18.8 vs. 132.1±16.8; p < 0.001), TIMI (4.3±1 vs. 3.1±1; p < 0.001) and CRUSADE (34.6±9.4 vs. 25.8±9.5; p < 0.001) scores at admission. All-cause in-hospital mortality was significantly more frequent in frail patients (11.9% vs. 5.6%; p < 0.001), as well as re-infarction (7.4% vs. 4.8%; p < 0.001), stroke (8.7% vs. 0.5%; p = 0.002) and major bleeding (7.9% vs. 1.6%; p = 0.002). On multivariate analysis, frailty remained independently associated with the primary endpoint (OR 5.63, [2.05-10.35]; p < 0.001). CONCLUSION: Frailty, identified by Fried criteria, is frequent in elderly patients with acute coronary syndromes, and it is an independent prognostic predictor for in-hospital mortality

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Infarto de miocardio postoperatorio en una cirugía ortognática de mandíbula / Postoperative myocardial infarction in an orthognatic jaw surgery

Las complicaciones cardiovasculares, en particular el infarto de miocardio perioperatorio, contribuyen significativamente a la morbimortalidad tras la cirugía no cardiaca. Presentamos el caso de un hombre de 41 años de edad, fumador, con dislipidemia, sometido a una cirugía ortognática bimaxilar, que desarrolló un síndrome coronario agudo en el periodo postoperatorio inmediato. El infarto agudo de miocardio se diagnosticó de manera temprana, realizándose de inmediato una angioplastia coronaria transluminal percutánea, que se tradujo en un resultado y evolución favorables (AU)

Cardiovascular complications, in particular perioperative myocardial infarctions, are central contributors to morbidity and mortality after non-cardiac surgery. We present a case of a 41-year-old male, smoker and dyslipidemic, who underwent bimaxillary orthognathic jaw surgery with the development of an acute coronary syndrome in the immediate postoperative period. We managed to early diagnose the myocardial infarction and promptly performed a percutaneous transluminal coronary angioplasty, resulting in a positive outcome (AU)

Postoperative myocardial infarction in an orthognatic jaw surgery. / Infarto de miocardio postoperatorio en una cirugía ortognática de mandíbula.

Cardiovascular complications, in particular perioperative myocardial infarctions, are central contributors to morbidity and mortality after non-cardiac surgery. We present a case of a 41-year-old male, smoker and dyslipidemic, who underwent bimaxillary orthognathic jaw surgery with the development of an acute coronary syndrome in the immediate postoperative period. We managed to early diagnose the myocardial infarction and promptly performed a percutaneous transluminal coronary angioplasty, resulting in a positive outcome.