Long-term impact of frailty on mortality and quality of life in mechanically ventilated acute myocardial infarction patients undergoing percutaneous coronary intervention.

BACKGROUND

Frailty is a recognized predictor of adverse outcomes after percutaneous coronary intervention (PCI), but its long-term association with mortality and health-related quality of life (HRQoL) remains uncertain. This study evaluated the three-year association between discharge frailty and subsequent frailty, mortality, and HRQoL in post-PCI patients.

METHODS

This retrospective cohort study included patients with acute myocardial infarction (AMI) who underwent PCI, required ICU/CICU admission with mechanical ventilation and/or advanced life support, and remained alive at routine 6-month follow-up. Frailty was assessed at discharge and reassessed after three years. HRQoL was assessed using the EQ-5D-3 L descriptive system and summarised using a study-specific level-sum impairment score; this was not a preference-weighted EQ-5D utility index.

RESULTS

Among 164 patients, 131 (79.9%) were frail at discharge. During three-year follow-up, 51 patients (31.1%) died. Crude mortality did not differ significantly between frail and non-frail patients (32.1%vs. 27.3%; p = 0.595). In adjusted logistic regression, moderate-to-severe discharge frailty was independently associated with death during the follow-up interval (adjusted OR 2.55; 95% CI 1.06-6.11; p = 0.036). Among survivors, 43 (38.1%) remained frail at follow-up. Moderate-to-severe discharge frailty was associated with moderate-to-severe frailty at three-year follow-up (adjusted OR 12.75; 95% CI 1.84-88.35; p = 0.010), although the wide confidence interval indicates limited precision and supports an exploratory interpretation. Poor HRQoL, defined as an EQ-5D-3 L level-sum score ≥8, was present in 33 survivors. Neither age >60 years (adjusted OR 1.56; 95% CI 0.44-5.53; p = 0.492) nor discharge frailty was independently associated with poor HRQoL.

CONCLUSION

Among mechanically ventilated AMI patients undergoing PCI who survived to routine 6-month follow-up, moderate-to-severe frailty at hospital discharge was independently associated with death during the three-year follow-up interval. It was also associated with moderate-to-severe frailty at follow-up, although this estimate was imprecise and should be interpreted as hypothesis-generating. Discharge frailty was not independently associated with poor long-term HRQoL.