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Angiographic and Procedural Characteristics in Frail Older Patients with Non-ST Elevation Acute Coronary Syndrome

Lookup NU author(s): Dr Ben Beska, Dr Hanna Ratcovich, Dr Alan Bagnall, Dr Richard Edwards, Dr Mohaned Egred, Emeritus Professor Reg Jordan, Dr Greg Mills, Dr Chris WilkinsonORCiD, Professor Azfar Zaman, Professor Vijay KunadianORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© 2023 The Author(s). Published by Radcliffe Group Ltd.Background: Angiographic and procedural characteristics stratified by frailty status are not known in older patients with non-ST elevation acute coronary syndrome (NSTEACS). We evaluated angiographic and procedural characteristics in older adults with NSTEACS by frailty category, as well as associations of baseline and residual SYNTAX scores with long-term outcomes. Methods: In this study, 271 NSTEACS patients aged ≥75 years underwent coronary angiography. Frailty was assessed using the Fried criteria. Angiographic analysis was performed using QAngio® XA Medis in a core laboratory. Major adverse cardiovascular events (MACE) consisted of all-cause mortality, MI, stroke or transient ischaemic attack, repeat unplanned revascularisation and significant bleeding. Results: Mean (±SD) patient age was 80.5 ± 4.9 years. Compared with robust patients, patients with frailty had more severe culprit lesion calcification (OR 5.40; 95% CI [1.75–16.8]; p=0.03). In addition, patients with frailty had a smaller mean improvement in culprit lesion stenosis after percutaneous coronary intervention (50.6%; 95% CI [45.7–55.6]) than robust patients (58.6%; 95% CI [53.5–63.7]; p=0.042). There was no association between frailty phenotype and completeness of revascularisation (OR 0.83; 95% CI [0.36–1.93]; p=0.67). A high baseline SYNTAX score (≥33) was associated with adjusted (age and sex) 5-year MACE (HR 1.40; 95% CI [1.08–1.81]; p=0.01), as was a high residual SYNTAX score (≥8; adjusted HR 1.22; 95% CI [1.00–1.49]; p=0.047). Conclusion: Frail adults presenting with NSTEACS have more severe culprit lesion calcification. Frail adults were just as likely as robust patients to receive complete revascularisation. Baseline and residual SYNTAX score were associated with MACE at 5 years.

Publication metadata

Author(s): Beska B, Ratcovich H, Bagnall A, Burrell A, Edwards R, Egred M, Jordan R, Khan A, Mills GB, Morrison E, Raharjo DE, Singh F, Wilkinson C, Zaman A, Kunadian V

Publication type: Article

Publication status: Published

Journal: Interventional Cardiology: Reviews, Research, Resources

Year: 2023

Volume: 18

Online publication date: 17/02/2023

Acceptance date: 10/09/2022

Date deposited: 04/05/2023

ISSN (print): 1756-1477

ISSN (electronic): 1756-1485

Publisher: Radcliffe Medical Media


DOI: 10.15420/ICR.2022.20


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Funder referenceFunder name
CS/15/7/31679British Heart Foundation