[2022/12/10] From the I-PAD registry, frailty status has a greater impact on MACLE (cardiovascular death, MI, stroke, heart failure hospitalization, major amputation, and revascularization) than age in patients undergoing endovascular therapy (EVT) for peripheral artery disease, according to Dr.Ken Nishikawa of Joetsu General Hospital and colleagues reported in the December issue of the Journal of Endovascular Therapy.
Impact of Frailty and Age on Clinical Outcomes in Patients Receiving EVT
The I-PAD registry enrolled 335 consecutive patients who underwent EVT for peripheral arterial disease at seven facilities in Nagano Prefecture from August 2015 to August 2016. Dr.Nishikawa and colleagues classified 323 of these patients according to age and Clinical Frailty Scale (CFS) into the frail elderly group (≧75 years, CFS ≧5), the non-frail elderly group (≧75 years, CFS ≦4), the frail nonelderly group (<75 years, CFS ≧5), and the non-frail elderly group (age <75, CFS ≦4) to determine the impact of frailty on clinical outcomes after EVT.
The median follow-up was 2.7 years. The primary endpoint of freedom from MACLE was 34.9% in the frail elderly group, 55.7% in the non-frail elderly group, 35.4% in the frail non-elderly group, and 63.0% in the non-frail non-elderly group (p<0.001), with all-cause mortality rates of 43.5%, 73.4%, 50.7%, and 90.9%, respectively (p<0.001). In multivariate analysis, frailty was independently associated with MACLE.
Dr.Nishikawa et al. concluded, "Frailty, as defined by CFS, may be a predictor of MACLE in patients with peripheral arterial disease undergoing EVT. By focusing on the degree of frailty rather than the age of patients with peripheral arterial disease when considering indications for EVT, we may be able to consider whether EVT strategies are appropriate and manage patient and caregiver expectations about the potential for improved functional outcomes."
Nishikawa K, et al. J Endovasc Ther. 2022; 29: 845-854
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