• Juan Sanchis, Clara Bonanad, Vicente Ruiz, Julio Fernández, Sergio García-Blas, Luis Mainar, Silvia Ventura, Enrique Rodríguez-Borja, Francisco J Chorro, Carlos Hermenegildo, Vicente Bertomeu-González, Eduardo Núñez, and Julio Núñez.
• Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain. Electronic address: sanchis_juafor@gva.es.
• Am. Heart J. 2014 Nov 1;168(5):784-91.

BackgroundGeriatric conditions may predict outcomes beyond age and standard risk factors. Our aim was to investigate a wide spectrum of geriatric conditions in survivors after an acute coronary syndrome.MethodsA total of 342 patients older than 65 years were included. At hospital discharge, 5 geriatric conditions were evaluated: frailty (Fried and Green scores), physical disability (Barthel index), instrumental disability (Lawton-Brody scale), cognitive impairment (Pfeiffer questionnaire), and comorbidity (Charlson and simple comorbidity indexes). The outcomes were postdischarge mortality and the composite of death/myocardial infarction during a 30-month median follow-up.ResultsSeventy-four (22%) patients died and 105 (31%) suffered from the composite end point. Through univariable analysis, all individual geriatric indexes were associated with outcomes, mainly mortality. Of all of them, frailty using the Green score had the strongest discriminative accuracy (area under the receiver operating characteristic curve 0.76 for mortality). After full adjustment including clinical and geriatric data, the Green score was the only independent predictive geriatric condition (per point; mortality: hazard ratio 1.25, 95% CI 1.15-1.36, P = .0001; composite end point: hazard ratio 1.16, 95% CI 1.09-1.24, P = .0001). A Green score ≥ 5 points was the strongest mortality predictor. The addition of the Green score to the clinical model improved discrimination (area under the receiver operating characteristic curve 0.823 vs 0.846) and significantly reclassified mortality risk (net reclassification improvement 26.3, 95% CI 1.4-43.5; integrated discrimination improvement 4.0, 95% CI 0.8-9.0). The incremental predictive information was even greater over the GRACE score.ConclusionsFrailty captures most of the prognostic information provided by geriatric conditions after acute coronary syndromes. The Green score performed better than the other geriatric indexes.Copyright © 2014 Elsevier Inc. All rights reserved.

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