“Frailty and cognitive impairment are associated with early adverse clinical events and angiographic differences in older adults with acute coronary syndrome”

Abstract Aims Geriatric vulnerabilities may compromise short-term prognosis in acute coronary syndrome (ACS); however, the prognostic value of geriatric assessment in older adults with ACS remains insufficiently explored. This study aimed to evaluate the association between selected geriatric assessment domains and 30-day early adverse clinical events and to explore whether frailty and cognitive impairment were associated with different angiographic patterns. Methods and results In a prospective observational single-center study, 211 patients aged ≥70 years hospitalized with ACS underwent assessment of frailty (FRAIL scale), functional status (Barthel Index), cognition (Pfeiffer’s SPMSQ), and comorbidity burden (Charlson Comorbidity Index). Logistic regression analyses were performed, and angiographic parameters were recorded. In univariable analyses, higher FRAIL scores (OR = 1.59, 95%CI = 1.21–2.09, p = 0.001) and higher SPMSQ error counts (OR = 1.56, 95%CI = 1.15–2.10, p = 0.004) were associated with 30-day early adverse clinical events. In the clinically informed multivariable model including all geriatric domains, higher SPMSQ error counts remained associated with the outcome (OR = 1.46, 95%CI = 1.06–2.00, p = 0.020). In a secondary reduced exploratory model, FRAIL scores (OR = 1.52, 95%CI = 1.14–2.01, p = 0.004) and SPMSQ error counts (OR = 1.46, 95%CI = 1.07–1.98, p = 0.016) were retained, with modest discrimination (AUC=0.70, 95%CI = 0.61–0.79, p < 0.001). Coexisting frailty and cognitive impairment identified a subgroup at particularly high risk, with 72.7% experiencing events, and exploratory angiographic analyses showed associations with culprit lesion calcification (OR = 3.08, 95%CI = 1.16–8.15), diffuse culprit disease (OR = 3.08, 95%CI = 1.10–8.61), single-vessel disease (OR = 2.85, 95%CI = 1.11–7.35), and thrombus in non-culprit lesions (OR = 20.75, 95%CI = 1.69–254.76). Conclusions In older adults with ACS, frailty and cognitive impairment were associated with 30-day early adverse clinical events and a different angiographic pattern in exploratory analyses. Incorporating brief nurse-administered geriatric assessment into routine ACS care may support risk stratification and multidisciplinary clinical decision-making.