• Gianluca Campo, Elisa Maietti, Elisabetta Tonet, Simone Biscaglia, Albert Ariza-Solè, Rita Pavasini, Matteo Tebaldi, Paolo Cimaglia, Giulia Bugani, Matteo Serenelli, Rossella Ruggiero, Francesco Vitali, Francesc Formiga, Juan Sanchis, Marcello Galvani, Monica Minarelli, Giulia Ricci Lucchi, Roberto Ferrari, Jack Guralnik, and Stefano Volpato.
• Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy.
• J. Gerontol. A Biol. Sci. Med. Sci. 2020 May 22; 75 (6): 1113-1119.

BackgroundThe number of older adults admitted to hospital for acute coronary syndrome (ACS) has increased worldwide. The aim of this study was to determine which scale of frailty or physical performance provides incremental improvements in risk stratification of older adults after ACS.MethodsA prospective cohort of 402 older (≥70 years) ACS patients were enrolled. Data about baseline characteristics, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) risk scores were collected. Before hospital discharge, seven scales of frailty and physical performance were measured. The 1-year occurrence of adverse events (cardiac death, reinfarction, and cerebrovascular accident [MACCE] and all-cause mortality) was recorded.ResultsOut of the 402 patients, 43 (10.5%) had a MACCE and 35 (8.7%) died. Following adjustment for confounding factors, scales of frailty and physical performance were associated with adverse events. Among the scales, the addition of short physical performance battery (SPPB) produced the highest incremental value over the initial model generated by baseline characteristics both for MACCE (ΔC-statistic 0.043, p = .04; integrated discrimination improvement (IDI) 0.054, p = .001; net reclassification improvement (NRI) 0.752, p < .001) and all-cause mortality (ΔC-statistic 0.063, p = .02; IDI 0.061, p < .001; NRI 1.022, p < .001). The addition of SPPB scale on top of GRACE or TIMI risk scores led to a considerable improvement in the prediction of MACCE and all-cause mortality (about 15% and 20%, respectively).ConclusionsThe assessment of the physical performance with SPPB scale before hospital discharge increases the ability to predict adverse events in older ACS patients and may be useful in the clinical decision-making process.Clinical Trial Registrationwww.clinicaltrials.gov NCT02386124.© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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