BACKGROUND AND AIMS Frailty is increasingly prevalent in people presenting with acute coronary syndrome (ACS). This high-risk group is typically excluded from trials of interventions in ACS, and there is uncertainty about the risks and benefits of invasive management. METHODS Patients with an ACS diagnosis between 2010 and 2015 in England were identified from Hospital Episode Statistics, with linked Office for National Statistics mortality data. Frailty was defined by the Hospital Frailty Risk Score. Causal inference analysis used regional variation in revascularization as an instrumental variable to estimate average treatment effects of revascularization on cardiovascular mortality up to 5 years in people presenting with ACS and low-, intermediate-, or high-risk frailty. RESULTS The analysis included 565 378 ACS patients, of whom 11.6% (n = 65 522) were at intermediate risk and 4.7% (n = 26 504) were at high risk of frailty. Intermediate and high frailty risks were associated with reduced likelihood of echocardiography, invasive angiography, or revascularization and increased likelihood of mortality and major adverse cardiovascular events compared with low frailty risk. Cardiovascular death at 5 years was 78.6%, 77.3%, and 75.7% in people at low, intermediate, and high frailty risk, respectively. Instrumental variable analysis suggested that revascularization resulted in a higher absolute reduction in cardiovascular mortality in high and intermediate frail risk patients compared with low risk at 1-year post-ACS. CONCLUSIONS Frailty is common in people presenting with ACS, where cardiovascular causes are the principal mode of death. Revascularization is associated with short- and long-term survival benefits in people at intermediate and high risk of frailty after adjustment for measured and unmeasured confounders.

中文翻译：

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急性冠脉综合征虚弱患者的血运重建：一项回顾性纵向研究。


背景和目的 虚弱在急性冠脉综合征 （ACS） 患者中越来越普遍。这个高危人群通常被排除在 ACS 干预试验之外，并且侵入性管理的风险和益处存在不确定性。方法 从医院事件统计中确定了 2010 年至 2015 年间在英格兰诊断为 ACS 的患者，并链接了国家统计局的死亡率数据。虚弱由医院虚弱风险评分定义。因果推断分析使用血运重建的地区差异作为工具变量，以估计血运重建对 ACS 和低、中或高危衰弱患者长达 5 年心血管死亡率的平均治疗效果。结果 分析包括 565 378 例 ACS 患者，其中 11.6% （n = 65 522） 处于中等风险，4.7% （n = 26 504） 处于衰弱高风险。与低衰弱风险相比，中度和高度衰弱风险与超声心动图、侵入性血管造影或血运重建的可能性降低以及死亡和主要不良心血管事件的可能性增加相关。低、中、高虚弱风险人群 5 年时心血管死亡分别为 78.6% 、 77.3% 和 75.7%。工具变量分析表明，与 ACS 后 1 年低风险患者相比，血运重建导致高危和中度虚弱患者的心血管死亡率绝对降低更高。结论 虚弱在 ACS 患者中很常见，其中心血管原因是主要的死亡方式。 在调整已测量和未测量的混杂因素后，血运重建与中高风险衰弱人群的短期和长期生存获益相关。