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Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV
BACKGROUND: Frailty has been recognized as an important prognostic indicator in patients with acute myocardial infarction (AMI). However, no study has focused on critical AMI patients. We aimed to determine the impact of frailty on short- and long-term mortality risk in critical AMI patients. METHOD...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9797732/ https://www.ncbi.nlm.nih.gov/pubmed/36588580 http://dx.doi.org/10.3389/fcvm.2022.1056037 |
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author | Bai, Weimin Hao, Benchuan Meng, Wenwen Qin, Ji Xu, Weihao Qin, Lijie |
author_facet | Bai, Weimin Hao, Benchuan Meng, Wenwen Qin, Ji Xu, Weihao Qin, Lijie |
author_sort | Bai, Weimin |
collection | PubMed |
description | BACKGROUND: Frailty has been recognized as an important prognostic indicator in patients with acute myocardial infarction (AMI). However, no study has focused on critical AMI patients. We aimed to determine the impact of frailty on short- and long-term mortality risk in critical AMI patients. METHODS: Data from the Medical Information Mart for Intensive Care (MIMIC)-IV database was used. Frailty was assessed using the Hospital Frailty Risk Score (HFRS). Outcomes were in-hospital mortality and 1-year mortality. Logistic regression and Cox proportional-hazards models were used to investigate the association between frailty and outcomes. RESULTS: Among 5,003 critical AMI patients, 2,176 were non-frail (43.5%), 2,355 were pre-frail (47.1%), and 472 were frail (9.4%). The in-hospital mortality rate was 13.8%, and the 1-year mortality rate was 29.5%. In our multivariable model, frailty was significantly associated with in-hospital mortality [odds ratio (OR) = 1.30, 95% confidence interval (CI): 1.20–1.41] and 1-year mortality [hazard ratio (HR) = 1.29, 95% CI: 1.24–1.35] as a continuous variable (per five-score increase). When assessed as categorical variables, pre-frailty and frailty were both associated with in-hospital mortality (OR = 2.80, 95% CI: 2.19–3.59 and OR = 2.69, 95% CI: 1.93–3.73, respectively) and 1-year mortality (HR = 2.32, 95% CI: 2.00–2.69 and HR = 2.81, 95% CI: 2.33–3.39, respectively) after adjustment for confounders. Subgroup analysis showed that frailty was only associated with in-hospital mortality in critically ill patients with non-ST-segment elevation myocardial infarction (STEMI) but not STEMI (p for interaction = 0.012). In addition, frailty was associated with 1-year mortality in both STEMI and non-STEMI patients (p for interaction = 0.447). The addition of frailty produced the incremental value over the initial model generated by baseline characteristics for both in-hospital and 1-year mortality. CONCLUSION: Frailty, as assessed by the HFRS, was associated with both in-hospital and 1-year mortality in critical AMI patients. Frailty improves the prediction of short- and long-term mortality in critical AMI patients and may have potential clinical applications. |
format | Online Article Text |
id | pubmed-9797732 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-97977322022-12-30 Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV Bai, Weimin Hao, Benchuan Meng, Wenwen Qin, Ji Xu, Weihao Qin, Lijie Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Frailty has been recognized as an important prognostic indicator in patients with acute myocardial infarction (AMI). However, no study has focused on critical AMI patients. We aimed to determine the impact of frailty on short- and long-term mortality risk in critical AMI patients. METHODS: Data from the Medical Information Mart for Intensive Care (MIMIC)-IV database was used. Frailty was assessed using the Hospital Frailty Risk Score (HFRS). Outcomes were in-hospital mortality and 1-year mortality. Logistic regression and Cox proportional-hazards models were used to investigate the association between frailty and outcomes. RESULTS: Among 5,003 critical AMI patients, 2,176 were non-frail (43.5%), 2,355 were pre-frail (47.1%), and 472 were frail (9.4%). The in-hospital mortality rate was 13.8%, and the 1-year mortality rate was 29.5%. In our multivariable model, frailty was significantly associated with in-hospital mortality [odds ratio (OR) = 1.30, 95% confidence interval (CI): 1.20–1.41] and 1-year mortality [hazard ratio (HR) = 1.29, 95% CI: 1.24–1.35] as a continuous variable (per five-score increase). When assessed as categorical variables, pre-frailty and frailty were both associated with in-hospital mortality (OR = 2.80, 95% CI: 2.19–3.59 and OR = 2.69, 95% CI: 1.93–3.73, respectively) and 1-year mortality (HR = 2.32, 95% CI: 2.00–2.69 and HR = 2.81, 95% CI: 2.33–3.39, respectively) after adjustment for confounders. Subgroup analysis showed that frailty was only associated with in-hospital mortality in critically ill patients with non-ST-segment elevation myocardial infarction (STEMI) but not STEMI (p for interaction = 0.012). In addition, frailty was associated with 1-year mortality in both STEMI and non-STEMI patients (p for interaction = 0.447). The addition of frailty produced the incremental value over the initial model generated by baseline characteristics for both in-hospital and 1-year mortality. CONCLUSION: Frailty, as assessed by the HFRS, was associated with both in-hospital and 1-year mortality in critical AMI patients. Frailty improves the prediction of short- and long-term mortality in critical AMI patients and may have potential clinical applications. Frontiers Media S.A. 2022-12-15 /pmc/articles/PMC9797732/ /pubmed/36588580 http://dx.doi.org/10.3389/fcvm.2022.1056037 Text en Copyright © 2022 Bai, Hao, Meng, Qin, Xu and Qin. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Bai, Weimin Hao, Benchuan Meng, Wenwen Qin, Ji Xu, Weihao Qin, Lijie Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV |
title | Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV |
title_full | Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV |
title_fullStr | Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV |
title_full_unstemmed | Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV |
title_short | Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV |
title_sort | association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: results from mimic-iv |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9797732/ https://www.ncbi.nlm.nih.gov/pubmed/36588580 http://dx.doi.org/10.3389/fcvm.2022.1056037 |
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