• Gary Tse, Mengqi Gong, Julia Nunez, Juan Sanchis, Guangping Li, Sadeq Ali-Hasan-Al-Saegh, Wing Tak Wong, Sunny Hei Wong, Wu William K K WKK Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Department of Anesthesia an, George Bazoukis, Gan-Xin Yan, Konstantinos Lampropoulos, Adrian M Baranchuk, Lap Ah Tse, Yunlong Xia, Tong Liu, Jean Woo, and International Health Informatics Study (IHIS) Network.
• Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China.
• J Am Med Dir Assoc. 2017 Dec 1; 18 (12): 1097.e1-1097.e10.

BackgroundFrailty has been identified as a risk factor for mortality. However, whether frailty increases mortality risk in patients undergoing percutaneous coronary intervention (PCI) has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and mortality outcomes in this setting.MethodsPubMed and EMBASE were searched until July 23, 2017 for studies evaluating the association between frailty measures and mortality in individuals who have undergone PCI.ResultsA total of 141 entries were retrieved from our search strategy. A total of 8 studies involving 2332 patients were included in the final meta-analysis (mean age: 69 years; 68% male, follow-up duration was 30 ± 28 months). Frailty was a significant predictor of all-cause mortality after PCI, with a hazard ratio (HR) of 2.97 [95% confidence interval (CI) 1.56-5.66, P = .001]. This was substantial heterogeneity present (I2: 79%). Subgroup analysis using the Fried score reduced I2 to 68% without altering the pooled HR (2.78, 95% CI 1.02-7.76; P < .05). Using the Canadian Study of Health and Aging Clinical Frailty Scale reduced I2 to 0% while preserving the pooled HR (5.99, 95% CI 2.77-12.95, P < .001).ConclusionsFrailty leads to significantly higher mortality rates in patients who have undergone PCI. Both the Fried score and Canadian Study of Health and Aging Clinical Frailty Scale are powerful predictors of mortality. These findings may support the notion that an alternative to invasive strategy should be considered in frail patients who are indicated for revascularization.Copyright © 2017. Published by Elsevier Inc.

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