Addition of the Tilburg Frailty Indicator to the classic Global Registry of Acute Coronary Events risk score improves its prognostic value in elderly patients with acute coronary syndrome

Abstract

INTROduCTION Since proper risk stratification in a growing population of patients with acute coronary syndrome (ACS) is challenging, a potential advantage of adding the elements of geriatric assessment to the commonly used Global Registry of Acute Coronary Events (GRACE) 2.0 scale in predicting the risk of 6‑month death requires investigation. ObjECTIvEs We aimed to evaluate if adding the Tilburg Frailty Indicator (TFI), Mini‑Mental State Ex‑ amination (MMSE), and multimorbidity assessed with the coronary artery disease (CAD)‑specific index to the classic GRACE scale would improve its predictive power. PATIENTs ANd mEThOds The study group included 196 patients aged at least 65 years (mean [SD], 74.4 [8] years), hospitalized for ACS. The risk of 6‑month mortality was assessed with the GRACE scale, frailty syndrome (FS) with the TFI questionnaire, cognitive impairment with the Polish adaptation of the MMSE, and multimorbidity with the CAD‑specific index. After 6 months, a follow‑up telephone call was performed. REsuLTs To assess whether adding TFI, MMSE, and CAD‑specific index to the GRACE 2.0 scale improves its prognostic value, normalization was carried out. In comparison with GRACE alone (area under the curve [AUC] = 0.713), a combination of GRACE (normalized) and TFI (normalized) had higher predictive power for 6‑month mortality (AUC = 0.737). The risk of death was 7 times greater (relative risk of 7.02) in the patients who scored over 55.8 points in the test based on the GRACE and TFI. In a multivariable logistic regression analysis, the model based on GRACE, TFI, and MMSE (the lowest value of the Akaike information criterion) most effectively predicted the risk of death. CONCLusIONs Adding the FS assessment to the traditional GRACE scale improves its prognostic value in elderly patients with ACS.