Frail patients much more likely to experience major bleeding events following PCI
Frailty is associated with a higher chance of suffering a major bleeding event up to one year after percutaneous coronary intervention (PCI), according to a new study published in the American Journal of Cardiology.
“Frailty is a geriatric syndrome that is defined as a state of reduced physiological reserve against pathological or iatrogenic stressors due to age-related impairments,” wrote lead author Kenji Kanenawa, MD, a cardiologist at Kokura Memorial Hospital in Japan, and colleagues. “Since frail patients are likely to be excluded from clinical studies due to those factors including an unwillingness of the patients to participate, the physician's decisions, and/or perceptions for poor prognosis, the causative role of frailty for the long-term bleeding risk after PCI remains unclear.”
Kanenawa et al. examined data from more than 2,400 patients who underwent PCI at the same facility in Japan from Feb. 24, 2016, to Dec. 4, 2017. The mean patient age was nearly 72 years old, and 44% of patients were 75 years old or older. In addition, 72.7% of patients were men.
Each patient was assessed using the Canadian Study of Health and Aging clinical frailty scale (CFS). The group was then separated into three groups: low CFS, intermediate CFS and high CFS. A total of 7.1% of patients were in the high CFS group.
A total of 112 patients—4.7% of the study cohort—died within one year of undergoing PCI. Just 1.5% of patients from the low CFS group died after one year, but that number increased for the intermediate CFS group (7.3%) and increased even more (30%) for the high CFS group.
Also, 47.3% of patients in the low CFS group had a high risk of bleeding as determined by their Academic Research Consortium High Bleeding Risk (ARC-HBR) score. That number was 83.2% for the intermediate CFS group and 89% for the high CFS group. Even patients that did not meet ARC-HBR criteria were still associated with a higher risk of a bleeding event following PCI.
In recent years, the authors explained, ARC-HBR criteria has been proposed as a “world-wide consensus” for determining when patients may face a higher risk of a major bleeding event. These findings, however, suggest “that frailty per se might be a predictor for major bleeding after PCI on top of HBR criteria.”
The full analysis is available here.
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