The effects of invasive treatment on patients with frailty and non-ST-segment elevation myocardial infarction

The effect of invasive treatment in patients with non-ST-segment elevation myocardial infarction (NSTEMI) with associated frailty remains undefined. This retrospective cohort study aimed to compare the outcomes of invasive treatment with conservative management in this specific patient population. We used the Tianjin Health and Medical Big Data Superplatform, with data from 82 hospitals in Tianjin, China, from January 2010 to March 2024. Patients with NSTEMI were included and divided into a non-frailty group (Hospital Frailty Risk Score [HFRS] < 5) and a frailty group (HFRS ≥ 5). Propensity score matching (PSM) was employed to balance the covariates, and invasive treatment was compared with conservative management. The primary endpoint was major adverse cardiac events (MACE), defined as the composite endpoint of all-cause mortality and recurrent myocardial infarction (MI) within 3 years. There were 73,823 NSTEMI patients (median age 66; 32.6% female) included in the analysis: 26,522 patients were in the frailty group, and 47,301 patients were in the non-frailty group. Among NSTEMI patients with frailty, 14,414 patients (54.3%) underwent invasive treatment. Following PSM yielding 6,040 well-matched pairs, frail patients undergoing invasive treatment had a lower risk of recurrent MI (subdistribution hazard ratio [sHR], 0.681; 95% confidence interval [CI] 0.614-0.754; P < 0.001), all-cause mortality (adjusted hazard ratio [aHR], 0.447; 95% CI 0.410-0.488; P < 0.001) and MACE (aHR, 0.516; 95% CI 0.481-0.553; P < 0.001), compared to conservative management. Similar results for invasive treatment compared to conservative management were observed in NSTEMI patients without frailty. Regardless of whether patients had associated frailty or not, invasive treatment was related to a decreased risk of recurrent MI and all-cause mortality in NSTEMI patients, when compared to conservative management.