Abstract 4147397: The Impact of Frailty on In-Hospital Outcomes of Percutaneous Coronary Intervention Performed for Stable Ischemic Heart Disease

Background: Ischemic heart disease (IHD) is a prevalent cardiovascular disease (CVD) associated with high morbidity and mortality. Over 600,000 percutaneous coronary interventions (PCI) are performed each year for IHD. Frailty and CVD are often interrelated, affecting disease and treatment outcomes. Frailty is a syndrome of physiological decline, characterized by marked vulnerability to adverse health outcomes. Frailty is prevalent in adults with IHD requiring PCI. However, the relationship between frailty and PCI outcomes is not well described. Methods: We analyzed the 2020 National Inpatient Sample (NIS) to identify index hospitalizations in which PCI was performed for patients >18 years with stable ischemic heart disease (SIHD), defined as PCI discharges without acute coronary syndromes (ACS), such as STEMI, NSTEMI, or unstable angina. Patients were categorized as frail if they had a hospital frailty risk score (HFRS) of 5 or higher, and non-frail if their score was below 5. We assessed in-hospital mortality, intracranial hemorrhage, gastrointestinal (GI) hemorrhage, anemia requiring blood transfusion, acute kidney injury (AKI), and hospital length of stay (LOS) between both groups. Hospital-level discharge weights were applied during statistical analyses to derive national estimates. Results: A total of 116,620 patients underwent inpatient PCI for SIHD, of whom 33,875 were frail adults. Frail patients had higher odds of in-hospital mortality (adjusted odds ratio [AOR] = 8.72, 95% confidence interval [CI]: 7.44-10.23), intracranial hemorrhage (AOR = 4.65, 95% CI: 2.18-10.82), GI hemorrhage (AOR = 2.03, 95% CI: 1.63-2.53), anemia requiring blood transfusion (AOR = 1.65, 95% CI: 1.32-2.06), and AKI (AOR = 2.12, 95% CI: 1.93-2.32) during the index hospitalization, as well as a longer LOS (median 5 days, interquartile range [IQR] 3-10 days, vs. median 2 days, IQR 2-3 days). Conclusion: Frail adults undergoing inpatient PCI for SIHD are at increased risk for in-hospital mortality and periprocedural complications, with longer LOS. Frailty is common among patients undergoing PCI for SIHD; understanding these outcomes may improve shared decision-making for patients considering PCI.