부산대학교 도서관

Introduction: Our aim was to determine whether frailty, a common syndrome in older adults, was associated with increased bleeding risk in the setting of acute myocardial infarction (AMI).Methods: We examined frailty among AMI patients age ≥65 treated at 775 U.S. hospitals participating in ACTION Registry-GWTG from 1/2015 - 12/2016. Frailty was classified based on impairments in 3 domains of functioning: walking (unassisted, assisted, non-ambulatory), cognition (normal, mildly impaired, moderately/severely impaired), and activities of daily living (ADLs; independent, partial assist ≥1 ADL, full assist ≥1 ADL). A summary frailty score was generated based on number of domains with none (0), mild (1) or full (2) impairments summed and grouped as (0, 1-2, 3-6). In-hospital major bleeding was defined using previous ACTION-GWTG Registry criteria. Multivariable logistic regression was used to examine the independent association between frailty and bleeding.Results: Among 129,330 AMI patients, 16.5% had any frailty. Frail patients were older, more often female, with more comorbidities (Table). Frail patients were less likely to undergo cardiac catheterization. The overall rate of major bleeding was 7.0%, and increased across categories of frailty. This trend occurred in the subgroup that underwent cardiac catheterization, but not in the subgroup managed conservatively. After adjustment, frailty was independently associated with bleeding among patients who underwent catheterization (OR 1.40, 95% CI 1.24-1.58) but not those managed conservatively (OR 0.96, 95% CI 0.81-1.14), when compared with non-frail patients.Conclusions: In our sample, frail patients had lower use of cardiac catheterization and higher risk of major bleeding (when catheterization was performed) than non-frail patients. These findings highlight the conundrum with invasive management in frail AMI patients, and the need for novel informed decision making approaches in this setting.