Frequency of Renal Dysfunction and Frailty in Patients ≥ 80 Years of Age With Acute Coronary Syndromes

Abstract

While a significant association between renal function and outcomes in patients with acute coronary syndromes (ACS) has been consistently described, little information exists about the magnitude of this association in patients at older ages. No study assessed the prognostic role of renal function according to frailty in patients with ACS. The LONGEVO-SCA registry included unselected ACS patients aged≥80 years. Frailty was asessesed by the FRAIL scale, and baseline creatinine clearance was calculated by the Cockroff-Gault formula. We evaluated the impact of renal function on mortality or readmission at 6-months according to frailty status by the Cox regression method. A total of 473 patients were assessed, with a mean age of 84.2 years. The distribution of patients across estimated glomerular filtration rate (eGFR) subgroups was as follows: a) <30 ml/min: n=76 (16.1%); b) 30-44 ml/min: n=147 (31.1%); c) 45-60 ml/min: n=136 (28.8%); and d)> 60 ml/min: n=114 (24.1%). Patients with lower eGFR values were older, had a higher proportion of comorbidities and other geriatric syndromes (p=0.001) and underwent less often an invasive management during admission (p<0.001). The incidence of mortality or readmission at 6 months progressively increased across renal function subgroups (p=0.001). After adjusting for potential confounders, this association became non significant (p=0.802). The association between eGFR and outcomes was only significant in patients without frailty (p=0.001). In conclusion, most patients aged≥80 years with NSTEACS had renal function impairment at admission. The association between renal function and outcomes was different according to frailty status.