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首页> 外文期刊>European heart journal. Acute cardiovascular care >Frailty is associated with worse outcomes in non-ST-segment elevation acute coronary syndromes: Insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial
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Frailty is associated with worse outcomes in non-ST-segment elevation acute coronary syndromes: Insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial

机译：在非ST段抬高的急性冠脉综合征中，虚弱与预后差有关：从TaRgeted血小板抑制阐明最佳策略到医学管理急性冠脉综合征（TRILOGY ACS）试验的见解

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Aims: Little is known regarding consequences of frailty in patients with acute coronary syndrome (ACS). We assessed the associations of frailty and outcomes in ACS patients who were participating in a clinical trial. Methods and results: The TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial randomized 9326 patients planned for medical management to prasugrel or clopidogrel. The primary endpoint was a composite of cardiovascular death, myocardial infarction (Ml), or stroke over a period of 30 months. A frailty score based upon the Fried score was self-reported at baseline in patients aged >=65 years. Five frailty questions were recorded for 4996/5102 (97.9%) patients: 72.3% were classified as not-frail (0 items), 23.0% as pre-frail (1-2 items), and 4.7% as frail ( >=3 items). Increasing frailty score was associated with older age, diabetes, and higher Global Registry of Acute Coronary Events (GRACE) scores. Frailty was associated with a higher unadjusted incidence of the primary endpoint (pre-frail vs not-frail: 29.2% vs 23.1%; hazard ratio [HR]: 1.39; 95% confidence interval [Cl]: 1. 19-1.61; p< 0.001; frail vs not-frail: 39.7% vs 23.1 %; HR: 1.76; 95% Cl: 1.36-2.28; p< 0.001), and all-cause mortality (pre-frail vs not-frail: 21.7% vs 15.0%; HR: 1.45; 95% Cl: 1.22-1.73; p<0.00l; frail vs not-frail: 30.2% vs 15.0%; HR: 1.98; 95% Cl: 1.47-2.68; p<0.00). After adjustment for baseline characteristics and GRACE covariates, frailty remained independently associated with the primary endpoint: pre-frail vs not-frail, HR: 1.33; 95% Cl: 1.15-1.54; p< 0.001; frail vs not-frail, HR: 1.52; 95% Cl: 1.18-1.98; p=0.002. There was no association of frailty with bleeding. Conclusion: Frailty is associated with the composite of cardiovascular death, Ml, or stroke. Frailty assessment contributes to risk prediction and adds to the GRACE score.
机译：目的：关于急性冠脉综合征（ACS）患者体弱的后果知之甚少。我们评估了参加临床试验的ACS患者虚弱与预后的关系。方法和结果：TaRed抑制血小板以阐明最佳治疗策略以管理急性冠脉综合征（TRILOGY ACS）试验将9326例计划进行普拉格雷或氯吡格雷药物治疗的患者随机分组。主要终点是30个月内心血管死亡，心肌梗死（M1）或中风的综合表现。在基线时，年龄大于等于65岁的患者自我报告了基于Fried评分的虚弱评分。对4996/5102（97.9％）的患者记录了五个脆弱的问题：72.3％被归为不脆弱（0件），23.0％被归为脆弱前（1-2件），而4.7％被划分为脆弱（> = 3）项）。体弱评分越高与年龄越大，糖尿病和急性冠状动脉事件全球登记表（GRACE）评分越高相关。体弱与主要终点的未调整发生率较高相关（体弱前与非体弱：29.2％vs 23.1％;危险比[HR]：1.39; 95％置信区间[Cl]：1。19-1.61; p <0.001;虚弱与不虚弱：39.7％vs 23.1％; HR：1.76; 95％Cl：1.36-2.28; p <0.001），以及全因死亡率（虚弱前与非脆弱：21.7％vs 15.0） ％; HR：1.45; 95％Cl：1.22-1.73; p ＜0.00l;脆弱对非脆弱：30.2％相对于15.0％; HR：1.98; 95％Cl：1.47-2.68; p ＜0.00 1。调整基线特征和GRACE协变量后，脆弱性仍与主要终点独立相关：脆弱前与非脆弱，HR：1.33; HR：1.33。 95％Cl：1.15-1.54; M + H ＝ 1.1。 p <0.001;虚弱与不虚弱，HR：1.52; 95％Cl：1.18-1.98; p ＝ 0.002。虚弱与出血没有关联。结论：虚弱与心血管死亡，MI或中风的综合症有关。脆弱性评估有助于风险预测并增加GRACE得分。

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