Sex-differential effect of frailty on long-term mortality in elderly patients after an acute coronary syndrome.

Abstract

BACKGROUND\nThe potential sex-differential effect of frailty in patients with acute coronary syndromes (ACS) has not been well-evaluated. We sought to examine the sex-differential association between frailty status on long-term mortality in elderly patients with an ACS.\n\n\nMETHODS AND RESULTS\nThis is a prospective observational single-center study that included 488 elderly patients (>65\u202fyears) hospitalized for ACS who survived the index hospitalization. Multivariate Cox regression was used to determine the association among the exposures (interaction of sex with Fried score and sex with Fried\u202f≥\u202f3) and all-cause mortality. The mean age of the sample was 78\u202f±\u202f7\u202fyears; 41% were female and the median Fried score was higher in women [3 (2-3) vs. 2 (1-2) points, p\u202f<\u202f0.001]. At a median follow-up of 3.12\u202fyears (IQR:1.38-5.13), 182 deaths (37.3%) were registered. The association of Fried\u202f≥\u202f3 with mortality varied across sex (p-value for interaction\u202f=\u202f0.022). In males, Fried\u202f≥\u202f3 was independently associated with all-cause death (HR\u202f=\u202f1.89; CI 95%:1.25-2.85, p\u202f=\u202f0.003). However, it showed a neutral effect on women (HR\u202f=\u202f0.92; CI 95%:0.57-1.49, p\u202f=\u202f0.726).\n\n\nCONCLUSIONS\nIn this work, we found that the frailty status assessed by Fried score was independently associated with mortality in elderly males but not in females with ACS.