Increasing frailty in acute myocardial infarction (AMI) patients ages 65 and older may be associated with major bleeding overall, and these patients may be at increased risk of bleeding when undergoing cardiac catherization, according to a study published Nov. 19 in JACC: Cardiovascular Interventions.

John A. Dodson, MD, MPH, FACC, et al., used ACC's Chest Pain – MI Registry to examine the association between frailty and bleeding risk among 129,330 AMI patients ages 65 and older who had been treated at 775 hospitals. Frailty was defined based on function in three areas: walking, cognition, and activities of daily living.

Among all patients, 83.6 percent had a frailty score of 0 and were considered fit/well, 11.1 percent had a score of 1 – 2 (vulnerable/mild frailty) and 5.6 percent had a score of 3 – 6 (moderate to severe frailty). Women and patients presenting with NSTEMI and STEMI had higher frailty scores. In addition, patients with increasing frailty were less likely to undergo PCI. Overall, 7 percent of the study population (8,505 patients) experienced the primary outcome of in-hospital major bleeding. Patients undergoing PCI had increasing bleeding rates based on frailty (fit/well: 6.4 percent; vulnerable/mild frailty: 10.3 percent; moderate to severe frailty: 13.6 percent). However, there was no increase in the in-hospital bleeding rate for frail patients who were managed conservatively without PCI.

According to the researchers, greater use of evidence-based strategies to reduce bleeding, such as radial access and appropriate anticoagulant dosing, could mitigate bleeding risk in some patients. The researchers conclude that “estimation of bleeding risk in frail patients prior to invasive care may facilitate clinical decision-making and the informed consent process.”

In a related editorial comment, John A. Bittl, MD, FACC, explains that “the present study helps to transform the rote recording of frailty from a mere quality metric in the medical record into an actionable diagnosis.”

Keywords: National Cardiovascular Data Registries, Chest Pain MI Registry, Myocardial Infarction, Registries, Chest Pain, Cardiac Catheterization, Percutaneous Coronary Intervention, Frail Elderly, Geriatrics

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