Infective endocarditis in diabetic patients: a different profile with prognostic

Background

Infective Endocarditis (IE) is a severe condition. Diabetes mellitus (DM) has been associated with a poor prognosis in other settings. Our aim was to describe the profile and prognosis of IE with and without DM and to analyse the prognostic relevance of DM-related organ damage.

Methods

Retrospective analysis of the Spanish IE Registry (2008–2020).

Results

The cohort comprises 5.590 IE patients with a mean age of 65.0±15.5 years, 3.764 (67.3%) were male. DM was found in 1.625 patients (29.1%) and 515 presented DM-related organ damage. DM prevalence during the first half of the study period was 27.6% vs. 30.6% in the last half, p=0.015. Patients with DM presented higher in-hospital mortality than those without DM (521 [32.1%] vs 924 [23.3%] p<0.001) and higher one-year mortality (640 [39.4%] vs 1.131 [28.5%] p<0.001). Among DM patients, organ damage was associated with higher in-hospital (200 [38.8%] vs 321 [28.9%], p<0.001) and one-year mortality (247 [48.0%] vs 393 [35.4%], p<0.001). Multivariate analyses showed an independent association of DM with in-hospital (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.16–1.55, p<0.001) and one-year mortality (OR = 1.38, 95% CI: 1.21–1.59, p<0.001). Among DM patients, organ damage was independently associated with higher in-hospital (OR = 1.37, 95% CI: 1.06–1.76, p=0.015) and one-year mortality (OR=1.59, 95% CI: 1.26–2.01, p<0.001)

Conclusions

The prevalence of DM among patients with IE is increasing and is already above 30%. DM is independently associated with a poor prognosis, particularly in the case of DM with organ damage.

Funding Acknowledgement

Type of funding sources: None.

Blood transfusion in patients with coronary syndromes and anaemia: a systematic review and a meta-analysis of randomized controlled trials

Background

The estimated prevalence of anaemia on admission in the setting of acute coronary syndromes (ACS) is between 10 to 43% and up to 57% of the patients may develop hospital-acquired anaemia. The best blood transfusion strategy in anemic patients with symptomatic coronary syndromes remains unclear.

Purpose

We aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCT) to assess the effect of different transfusion strategies in anemic patients with coronary syndromes on 30-day mortality, major adverse cardiovascular events (MACE), and non-cardiovascular complications.

Methods

We searched for all randomized trials comparing restrictive to conservativestrategy in patients with coronary syndromes published up to 16 th November 2021 on PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov without language, sample size, publication date or other data restrictions. All studies were assessed for bias using Cochrane risk of bias, and meta-analysed using a random effect model. The quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The pre-specified primary outcome was all-cause death at 30 days. The secondary outcome was the composite of non-fatal recurrent myocardial infarction, non-fatal stroke, emergency revascularization, or cardiovascular death at 30 days (MACE). Safety endpoint was a combination of de novo or worsening congestive heart failure, stent thrombosis, venous thromboembolism, pneumonia, or blood stream infection.

Results

Three RCT (CRIT, MINT and REALITY) were included with 820 patients. The risk of bias was considered low, except for blinding of patients and healthcare professionals. Across the three studies, a total of 55 patients died in the first 30 days. We found no differences between restrictive transfusion strategy compared with liberal transfusion strategy in all-cause death at 30 days (risk ratio [RR]: 1.61, 95% confidence interval [CI] 0.38–6.90, I2=59%, MACE (RR: 1.16, 95% CI 0.49–2.71; I2=62%; figure 1) and incidence of adverse events (RR: 1.52, 95% CI 0.56–4.09; I2=60%; figure 2). The quality of evidence was considered low to moderate due to concerns of imprecision and inconsistency.

Conclusion(s)

Liberal and conservative strategies of blood transfusion show similar results in anaemic patients with symptomatic coronary syndromes. As blood is a scarce resource, our data support the current guideline recommendation of restrictive strategy of transfusion in anaemic patients with acute coronary syndromes.

Funding Acknowledgement

Type of funding sources: None.

Correlation between atrial electrocardiographic indexes and left atrial enlargement in competitive athletes. From the ALMUDAINA case-control study

Background

Left atrial (LA) remodelling and enlargement in athletes is a well-kown component of the athlete's heart. However, information about the correlation between of LA enlargement and atrial electrophysiological features in athletes is scarce.

Purpose

Our aim was to characterize LA enlargement, P-wave duration, and the prevalence of interatrial block (IAB) in competitive athletes (with and without LA enlargement) and in controls.

Methods

ALMUDAINA (Analysis of Left atrial Measurements of Ultrasound Dilation Among International and National Athletes) was a nationwide, cross-sectional study involving 9 hospitals and sport clinics across Spain. Cases fulfilled the international consensus definition of a competitive athlete and were currently engaged in skill, power, mixed or endurance disciplines at a national or international level. The following P-wave parameters were analysed: 1) duration 2) voltage in lead I and 3) the presence of interatrial block (IAB). LA enlargement was defined as an indexed volume by body surface area ≥34 ml/m2, measured by transthoracic echocardiography. A contemporary cohort of otherwise healthy and active controls was used as a comparison group.

Results

Baseline clinical and echocardiographic characteristics of both cohorts are summarised in table 1 whereas electrocardiographic characteristics are displayed in table 2, respectively. 356 subjects were included, 308 athletes (mean age: 36.4±11.6 years) and 48 controls (mean age: 49.3±16.1 years). Athletes showed a higher mean LA indexed volume (29.8±8.6 vs. 25.6±8.0 mL/m2, P=0.006) and higher prevalence of LA enlargement (113 [36.7%] vs. 5 [10.4%], P<0.001), but there were no relevant differences in P-wave duration (106.3±12.5 ms vs 108.2±7.7 ms; P=0.31), voltage in lead I (0.08±0.04 vs. 0.08±0,04 mV; P=0.79) and the prevalence of IAB (40 [13.0%] vs. 4 [8.3%], P=0.36). Only a case of advance IAB was detected, in an athlete without LA enlargement. Among athletes, those with LA enlargement (113, 36.7%) had higher P-wave duration (110.3±14.1 vs. 103.0±10.9 ms, P<0.001) and a higher prevalence of interatrial blockade (23 [20.4%] vs. 17 [8.8%], P=0.004), but similar voltage of P-wave in lead I (0.08±0.003 vs. 0.08±0.05 mV, P=0.689). In a multivariate analysis, competitive training was independently associated with LA enlargement (odds ratio [OR] 14.7, 95% confidence interval [CI] 4.7–44.0; P<0.001) but was not associated with P-wave duration (OR 1.02, 95% CI: 0.99–1.04; P=0.19) or IAB (OR 1.4, 95% CI 0.7–3.1; P=0.34).

Conclusions

LA enlargement is prevalent in adult competitive athletes. However, ECG indexes of atrial electrophysiology were not different from healthy controls. Our data suggest that LA enlargement and IAB are two different entities.

Funding Acknowledgement

Type of funding sources: None.

Advanced interatrial block precedes atrial fibrillation and stroke. The prospective interatrial Block And Yearly EventS (BAYES) registry

Background

Advanced interatrial block (IAB), prolonged and bimodal P waves in surface ECG inferior leads, is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm precedes AF and stroke in elderly outpatients with structural heart disease, a group not previously studied.

Methods

Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups according to P-wave characteristics.

Results

Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days; 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.7–5.1, p<0.001), stroke (HR 3.8, 95% CI 1.4–10.7, p=0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4, p=0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07, p<0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06, p<0.001), and mortality (HR 1.04, 95% CI 1.00–1.08, p=0.021).

Conclusions

The presence of advanced IAB in sinus rhythm is a risk factor for AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality. Figure. Age- and sex-adjusted linear and non-linear association between P-wave duration (msec) and atrial fibrillation (A), stroke (B), and atrial fibrillation or stroke (C) risk. Results of a generalized additive model with spline smoothing functions and 4 degrees of freedom.

Figure 1. Kaplan-Meyer curves of survival free of atrial fibrillation (A), stroke (B) and atrial fibrillation or stroke (C) in patients with normal P-wave, partial interatrial block (IAB) and advanced IAB.

Funding Acknowledgement

Type of funding source: None

Long-term prognostic benefit of beta-blockers use after discharge in patients with Tako-Tsubo syndrome

Background

Tako-tsubo Syndrome (TS) seems to be associated with a catecholamine-mediated mechanism. However, the impact of beta-blockers (BB) in-hospital and after discharge still remain uncertain. Objectives: The purpose of the study was to examine whether BB use after discharge in patients with TS, was associated with lower long-term mortality and recurrence.

Methods

Using a national multicentre large-scale inpatient database (RETAKO Registry), we analysed patients with a definitive TS diagnosis.

Results

A total of 970 patients were analysed (568 with BB therapy and 402 no-BB therapy). After discharge and over a median of follow-up of 1.1 years, treatment with BB have no shown prognostic effectiveness in terms of mortality and TS recurrence in unadjusted and adjusted Cox analysis (HR 0.86; 95% CI: 0.59 to 1.27; and 0.95; 95% CI: 0.57–1.13, respectively).

Conclusions

This data suggests that use of beta-blockers after hospital discharge has not shown long-term prognostic benefit in patients with Tako-tsubo Syndrome.

Prognostic impact of BB in TS.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Retako webpage was funded by a non-conditioned Astrazeneca scholarship.

Electrocardiographic characteristics and associated outcomes in patients with Takotsubo syndrome. Insights from the RETAKO registry

Background

Our aim was to describe the prevalence and prognostic significance of electrocardiographic features in patients with Takotsubo syndrome (TTS).

Methods

Our data come from the Spanish Multicenter REgistry of TAKOtsubo syndrome (RETAKO). All patients with complete electrocardiogram were included.

Results

246 patients were studied, mean age was 71.3±11.5 and 215 (87.4%) were women. ST-segment elevation was seen in 143 patients (59.1%) and was present in ≥2 wall leads in 97 (39.8%). Exclusive elevation in inferior leads was infrequent (5 - 2.0%). After 48 hours, 198 patients (88.0%) developed negative T-waves in a median of 8 leads with a mean amplitude of 0.7±0.5 mV. Mean corrected QT interval was 520±72 ms and it was independently associated with the primary endpoint of all-cause death and nonfatal cardiovascular events (p=0.002) and all-cause death (p=0.008). A higher heart rate at admission was also an independent predictor of the primary endpoint (p=0.001) and of developing acute pulmonary edema (p=0.04). ST-segment elevation with reciprocal depression was an independent predictor of all-cause death (p=0.04). Absence of ST-segment deviation was a protective factor (p=0.005) for the primary endpoint. Arrhythmias were independently associated with cardiogenic shock (p<0.001).

Conclusion

Prolonged corrected QT interval, arrhythmia, heart rate at admission and broader repolarization alterations are associated with a poor outcome in TTS.

Typical ECG at admission and after 48h.

Funding Acknowledgement

Type of funding source: None

P3799Experimental model of interatrial block by Bachmann bundle conduction block

Background

The recognition of advanced IAB is becoming an important clinical landmark due to its association with atrial fibrillation, the so-called Bayes' syndrome. The electrocardiographic (ECG) criteria of interatrial block (IAB) have been established. A P-wave duration ≥120 ms is considered partial IAB and if there is a biphasic P-wave in the inferior leads advanced IAB. The pathophysiology of this ECG finding has been largely discussed. IAB has been explained as the result of the retrograde activation of left atrium due to complete block in the Bachmann bundle (BB).

Purpose

To assess the ECG changes resulting of blocking BB conduction in an experimental healthy animal model. Additionally, to compare the pattern of activation of the left atrium before and after the block.

Methods

Six open-chest anesthetized healthy adult swine were studied. A twelve-lead ECG was continuously recorded. The BB was epicardially accessed at the traversus sinus of the pericardium. At that level, monopolar electrosurgical energy (3 animals) and radiofrequency energy (3 animals) (Boston Scientific Blazer™ II XP, 8 mm tip) was applied until extensive tissue disruption was present and permanent P-wave changes observed. An electroanatomical map CARTO® XP (Biosense Webster Inc) of the right and left atrium was performed in two animals before and after energy deployment. Finally, animals were sacrificed, and tissue samples collected for anatomopathological examination.

Results

After energy application, all animals showed a significant prolongation of P-wave duration from 59±11 msec to 115±13 msec (p<0.001) with appearance of a biphasic P-wave pattern in the inferior leads. The CARTO® maps showed a change in left atrial activation, cranio-caudal at baseline and caudo-cranial at the end of the procedure. (Figure) The histological analysis showed transmural lesions at the level of the BB in all the specimens.

ECG/CARTO maps: Baseline and after block

Conclusion

IAB ECG pattern, accompanied by a marked change in the activation of the left atrium, develops after blocking the conduction at the level of the BB in an experimental healthy animal model. These results confirm the association of IAB and BB conduction block and suggest that IAB represents an independent entity.

Acknowledgement/Funding

Fundaciό Privada Daniel Bravo Andreu

P2525Relationship of Charlson Comorbidity Index with adverse events in elderly patients with Acute Coronary Syndromes: an analysis from LONGEVO-SCA Registry

Background

Elderly patients with Acute Coronary Syndromes (ACS) are under-represented in clinical trials and they have higher risk of new due their comorbidities. Charlson Comorbidity Index (CCI) is an established tool for evaluating the burden of comorbidity status and a high score of CCI is related with an increased risk of death.

Purpose

The aim of this study was to analyze the relationship of CCI in adverse outcomes at short-term follow-up in elderly patients admitted by an ACS.

Methods

The prospective multicenter LONGEVO-SCA included unselected elderly patients (≥80 years old) hospitalized after non-STACS. In this substudy, we analyze the influence of comorbidities, comparing the relationship between quartiles of CCI and adverse events at 6 months follow-up of CCI.

Results

We analyzed 520 patients (mean age 84.4±3.6 years; 320 (61.5%) male). 196 (37.6%) were classified into Q1, 105 (20.2%) into Q2, 93 (17.9%) into Q3 and 126 (24.2%) into Q4. No differences were observed in treatment at discharge across different quartiles for aspirin (p=0.648), beta-blockers (p=0.908) or statins (p=0.756). We observed a significant increase for all-cause mortality [9 (4.8%) vs 10 (10.2%) vs 11 (12.0%) vs 32 (26.0%); p<0.001] and readmissions [36 (18.4%) vs 21 (20%) vs 33 (35.5%) vs 48 (38.1%); p<0.001] respectively from Q1 to Q4. After Cox multivariate regression analysis, CCI was independently associated with mortality or readmissions [HR 1.15, 95% CI (1.06–1.26); p=0.001] and patients into high quartile had 6-fold risk of mortality [HR 6.19, 95% CI (2.95–12.99); p<0.001]. Kaplan Meier analysis showed that patients in the highest quartiles had significantly worse prognosis during the follow-up with high risk of all-cause mortality and readmissions (both p<0.001).

Event Free Survival according Charlson

Conclusions

In LONGEVO-SCA registry, we validated for the first time CCI as an independent factor related with adverse events. Patients into high quartiles of CCI had significantly worse prognosis during the follow-up and elderly patients into Q4 had 6-fold risk of mortality compared to Q1 patients.

P4535Discharge treatment with ACE inhibitor/ARB after a heart failure hospitalization is associated with a better prognosis irrespectively of left ventricular ejection fraction

Background

Medical therapy could improve the prognosis of real-life patients discharged after a heart failure (HF) hospitalization.

Purpose

We aimed to determine the impact of discharge HF treatment on mortality and readmissions in different left ventricular ejection fraction (LVEF) groups.

Methods

Multicentre prospective registry in 20 Spanish hospitals. Patients were enrolled after a HF hospitalization.

Results

A total of 1831 patients were included (583 [31.8%] HF with reduced ejection fraction [HFrEF]; 227 [12.4%] HF with midrange ejection fraction [HFmrEF]; 610 [33.3%] HF with preserved ejection fraction [HFpEF], and 411 [22.4%] with unknown LVEF. Angiotensin-converting enzyme (ACE) inhibitors/Angiotensin II receptor blockers (ARB) at discharge were independently associated with a reduction in: i) all-cause mortality: hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.41–0.74, P<0.001, with a similar effect in the four groups; ii) mortality due to refractory HF HR 0.45, 95% CI 0.29–0.64, P<0.001, with a similar effect in the three groups with known LVEF; iii) mortality/HF admissions (HR 0.61; 95% CI: 0.50–0.74), more evident in HFrEF (HR 0.54; 95% CI: 0.38–0.78) compared to HRmEF (HR 0.64; 95% CI 0.40–1.02), orHFpEF (HR 0.70; 95% CI 0.53–0.92).Inpatients with HFrEFtriple therapy (ACE inhibitor/ARB+ betablocker+ mineralocorticoid receptor antagonist) was associated with the lowest mortality risk (HR 0.21; 95% CI: 0.08–0.57, P=0.002) compared to patients that received none of these drugs.

Events according to the number of drugs – HFrEF (n=583) 0 (n=14) 1 (n=98) 2 (n=160) 3 (n=294) P Death or heart failure readmissions 10 (71.4) 58 (59.2) 66 (41.3) 106 (36.1) <0.001 All-cause mortality 9 (64.3) 28 (28.6) 31 (19.4) 36 (12.2) <0.001 Mortality due to refractory heart failure 7 (50.0) 14 (14.3) 17 (10.6) 17 (5.8) <0.001 – HFmrEF (n=227) 0 (n=18) 1 (n=57) 2 (n=81) 3 (n=65) P Death or heart failure readmissions 9 (50.0) 35 (61.4) 34 (42.0) 25 (38.5) 0.057 All-cause mortality 5 (27.8) 18 (31.6) 15 (18.5) 11 (16.9) 0.191 Mortality due to refractory heart failure 3 (16.7) 7 (12.3) 7 (8.6) 4 (6.2) 0.475 – HFpEF (n=610) 0 (n=61) 1 (n=242) 2 (n=219) 3 (n=69) P Death or heart failure readmissions 32 (52.5) 97 (40.1) 89 (40.6) 20 (29.0) 0.057 All-cause mortality 20 (32.8) 41 (16.9) 32 (14.6) 10 (14.5) 0.017 Mortality due to refractory heart failure 11 (18.0) 18 (7.4) 13 (5.9) 4 (5.8) 0.041 Outcomes according to the number of medications at discharge.

Kaplan-Meier Curves for study outcomes

Conclusions

Discharge treatment with ACE inhibitor/ARB after a HF hospitalization is associated with a reduction in all-cause and refractory HF mortality, irrespectively of LVEF.

P3612Validation of Charlson Comorbidity Index to predict adverse events in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: an analysis from LONGEVO-SCA Registry

Background

Aging is frequently characterized by the coexistence of several comorbid conditions that increase the adverse prognosis during hospitalization. There are few scores to analyze the impact of comorbidities in prognosis. Charlson Comorbidity Index (CCI). This score evaluates the burden of comorbidity in general population but the influence within cardiac diseases is unknown.

Purpose

The aim of this study was to analyze the relationship of CCI in adverse outcomes at short-term follow-up in elderly patients with atrial fibrillation (AF) admitted after an acute coronary syndrome (ACS).

Methods

The prospective multicenter LONGEVO-SCA included unselected elderly patients hospitalized after non-STACS. In this substudy, we analyze the influence of comorbidities in elderly AF patients, comparing high quartiles of CCI (Q3-Q4: high burden of comorbidities) to low quartiles (Q1-Q2) and the predictive performance of adverse events at 6 months follow-up of CCI.

Results

We analyzed 531 patients (mean age 84.4±3.6 years; 322 (60.6%) male). 128 (24.1%) had AF diagnosis. 91 (71.1%) patients were classified into Q1-Q2 and 37 (28.9%) patients into Q3-Q4. We analyzed the association of clinical factors and adverse events and, after Cox multivariate regression analysis, CCI was independently associated with readmissions [HR 1.19, 95% CI (1.02–1.39); p=0.020) and all-cause mortality [HR 1.32, 95% CI (1.09–1.59); p=0.003]. Patients into Q3-Q4 had higher risk of mortality than patients into Q1-Q2 [HR 5.52, 95% CI (1.01–30.3); p=0.049]. Kaplan Meier analysis showed that AF patients into Q3-Q4 had significantly worse prognosis during the follow-up with high risk of all-cause mortality (p=0.034) and readmissions due to ACS (p=0.027). We observed good predictive performance of CCI for mortality (c-statistic 0.705; p<0.001) and modest predictive performance for readmissions (c-statistic 0.627; p<0.001).

Event Free Survival according Charlson

Conclusions

Patients into high quartiles of CCI had higher risk of adverse events during the follow-up. CCI was an independent predictor of all-cause mortality and readmissions in elderly patients. Indeed, this is the first time to validate CCI to predict adverse events in AF patients with ACS.

P2530Frailty assessment in atrial fibrillation patients with acute coronary syndromes: a subanalysis from LONGEVO-SCA registry

Background

Different studies have observed a significant correlation between frailty, morbidity and mortality in elderly patients with cardiovascular diseases.Several scores have been developed to assess frailty in elderly patients. The FRAIL scale is a bed-side and easy tool that evaluates 5 items: fatigue, resistance, ambulation, concomitant diseases and weight loss. However, the evaluation of frailty status in AF patients with ACS is scarce.

Purpose

The aim of this study was to analyze the management of elderly patients with AF and ACS and the predictive value of frailty for adverse events.

Methods

The prospective multicentre LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. In this substudy, we divided patients according to rhythm status (AF or sinus rhythm [SR]) and to frail status. We validated the predictive performance of FRAIL scores for adverse events at 6 months follow-up.

Results

We analyzed 531 patients (mean age 84.4±3.6 years; 322 (60.6%) male). 128 (24.1%) had AF diagnosis and 145 (27.3%) patients were frail. Frail AF patients had higher risk of global mortality [HR 2.61, (95% CI 1.28–5.31; p=0.008)], readmissions [HR 2.28, (95% CI 1.37–3.80); p=0.002)] and the composite endpoint [HR 2.28, (95% CI 1.44–3.60); p<0.001)] compared with non-frail SR patients. After multivariate adjustment, Frail score [HR 1.41; 95% CI (1.02–1.97); p=0.040] was independently associated with mortality. Kaplan Meier analysis showed that frail AF patients had significantly worse prognosis during the follow-up with high risk of global mortality (log rank p=0.024) and readmission (log rank p<0.001) followed closely by those frail SR patients.

Event Free Survival according Frailty

Conclusions

In the LONGEVO-SCA registry, frail AF patients have 2-fold risk of adverse events compared to non-frail SR patients. Frailty status was an independent condition associated with high risk of adverse events at 6 months of follow-up.

P1752Impact of frailty addition in ischemic and bleeding risk scores in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: a subanalysis from LONGEVO-SCA registry

Background

The prevalence of Atrial Fibrillation (AF) and Acute Coronary Syndrome (ACS) increases with age. Frail older adults are at high risk of multiple adverse events during admission and short term mortality. FRAIL score is an easy tool that evaluates: fatigue, resistance, ambulation, concomitant diseases and weight loss.

Purpose

The aim of this study was to validate FRAIL score in AF elderly patients with ACS related to adverse events and the impact of its addition in clinical scores.

Methods

The prospective multicenter LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. We analyzed the predictive performance of FRAIL score in AF subgroup for adverse events (primary endpoint mortality or readmission) and the impact of frailty addition in ischaemic and bleeding scores.

Results

We analyzed 531 patients. 128 (24.1%) of them have AF (main age 84.6±3.7 years; 78 (61%) male) and 27.3% were frail (defined by FRAIL score ≥3). Frail AF patients had more prevalent comorbidities and received less evidence-based ACS therapies at discharge as oral anticoagulation (66% vs 60%; p<0.001) or statins 96.3% vs 82.6%; p<0.001). We analyzed the predictive performance of FRAIL score to adverse events and observed a modest predictive performance for mortality (c-statistic 0.648; 95% CI [0.605–0.690]; p<0.001), readmissions (c-statistic 0.600; 95% CI [0.557–0.642]; p<0.001) and for composite endpoint (c-statistic 0.620; 95% CI [0.577–0.663]; p<0.001). We compared the addition of FRAIL score to the original risk scores and observed a significant improvement for the primary endpoint with the addition to CHA2DS2-Vasc score (p=0.009), GRACE (p<0.001) and CRUSADE scores (p<0.001). (Table)

C-indexes for mortality or readmissions C-index 95% CI p p* Z* CHA2DS2-VASc score 0.619 0.576 to 0.662 <0.001 0.009 2.586 CHA2DS2-VASc score + FRAIL 0.641 0.598 to 0.683 <0.001 HAS-BLED score 0.649 0.606 to 0.691 <0.001 0.445 0.764 HAS-BLED score + FRAIL 0.634 0.590 to 0.675 <0.001 GRACE score 0.599 0.554 to 0.644 0.006 0.001 3.930 GRACE score + FRAIL 0.602 0.556 to 0.646 <0.001 CRUSADE score 0.660 0.613 to 0.705 0.051 0.001 3.287 CRUSADE score + FRAIL 0.664 0.617 to 0.709 <0.001 CI: Confidence interval. *For c-index comparison. p: P value.

Conclusions

This is the first validation of the FRAIL score in AF patients under ACS with a modest predictive performance to adverse events. The addition of frailty to clinical scores improved the predictive performance to adverse events in AF patients.

Prevalence of peripheral arterial disease and prior stroke in octogenarians with symptomatic severe aortic stenosis or severe coronary artery disease: influence in management and outcome

AIM

Severe aortic stenosis (SAS) and severe coronary artery disease (SCAD) are the most frequent reasons to perform cardiac surgery in octogenarians. Non-coronary vascular disease is frequently present in these patients.

METHODS

We assessed the prevalence and impact of previous stroke (PS) and peripheral arterial disease (PAD) on the management and outcome of 130 consecutive symptomatic patients (80 years old with SAS or SCAD.

RESULTS

Mean age was 82.8+/-3.1 years. PS was present in 24 patients (18.5%) and PAD in 15 (11.5%). We found a non-significant trend to a higher prevalence of PAD in patients with SCAD than in patients with SAS (14.5% vs 6.4%, P=0.13), while no relevant differences were seen for PS prevalence (19.3% vs 17%, P=0.75). Patients with PS tended to be operated less frequently than patients without PS (20.8% vs 37.7%, P=0.08), while no relevant differences were seen for patients with and without PAD (26.7% vs 35.7%, P=0.5). Thirty-nine patients (30%) died during follow-up, mean of 1.1(0.7 years (median 1 years; 100% complete). There was a trend to a worse prognosis in patients with PAD (adjusted hazard ratio [HR] 2.2; 95% confidence interval [CI] 0.96-4.8; P=0.06), while PS showed no independent influence on survival (adjusted HR 1.3, 95% CI 0.6-2.8, P=0.53).

CONCLUSIONS

PS and PAD are frequently present in octogenarians with SAS or SCAD. Patients with PS show a similar long-term mortality, but tend to be operated less frequently. On the other hand, PAD did not influence the decision of surgical treatment, but is associated with a lower survival rate.