Three-year risk of adverse outcomes in patients with myocardial infarction over 70 years of age, taking into account frailty syndrome and myocardial revascularization

Aim. To develop a prognostic model for the probability of adverse cardiovascular events over three years in patients over 70 years of age with prior myocardial infarction (MI), frailty syndrome, and myocardial revascularization.

Material and methods. This prospective study included 92 patients over 70 years of age with MI. Clinical and history data, the Charlson comorbidity index, general laboratory data, myocardial stress and fibrosis biomarkers (NT-proBNP and ST-2), and structural and functional cardiac parameters were assessed. The Age Is Not a Barrier questionnaire was used to identify frailty. The median follow-up period (Q1; Q3) was 1045 (367; 1099) days. An adverse cardiovascular event was chosen as the endpoint. Nonparametric statistical methods, Cox regression, and logistic regression were used.

Results. The mean age of patients was 77,3±2,4 years. Using Cox regression, following 3-year predictors of adverse cardiovascular events were identified: age ≥80 years (p=0,001), prior MI (p=0,011), CKD-EPI glomerular filtration rate on admission ≤55 ml/min/1,73 m2 (p=0,008), and pulmonary artery systolic pressure ≥38 mm Hg (p=0,022), Simpson’s ejection fraction ≤45% (p<0,001), left ventricular local contractility index ≥1,55 (p=0,001), serum NT-proBNP ≥650 pg/ml (p<0,001), serum ST2 ≥8,2 ng/ml (p<0,001), the Age Is Not a Barrier questionnaire score ≥3 (p<0,001), Charlson comorbidity index ≥6 points (p=0,001). Percutaneous coronary intervention (PCI) during the current hospitalization was associated with an improved prognosis for patients within three years (odds ratio 0,28 [0,14-0,58], p=0,001). The regression prognostic model for patients over 70 years of age with MI included three following parameters: the Age Is Not a Barrier questionnaire score ≥3, PCI performed during hospitalization for MI (Yes/No), and Simpson’s left ventricular ejection fraction (%).

Conclusion. PCI in patients over 70 years of age with MI and frailty reduces the risk of adverse cardiovascular events over three years. Prediction of adverse cardiovascular events is possible based on the proposed prognostic model.

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