Among patients undergoing PCI in the U.S., frailty is common with higher frailty status associated with increased risk of mortality, according to a brief report published June 16 in JACC. Patients categorized as severely frail were few but exhibited an exceptionally high risk.

Analyzing data from the ACC’s CathPCI Registry, Benjamin Peterson, MD, MPH, et al., included 1,316,390 patients (mean age 74.6 years, 34% female) undergoing PCI from October 2018 to December 2021. Frailty was assessed using the Canadian Study of Healthy Aging Clinical Frailty Scale (CFS) and broken up into the following classifications: no frailty (CFS 1-2), prefrail (CFS 3-4), frail (CFS 5-6) and severely frail (CFS 7-9). Patients in the highest tertile of bedside mortality score were considered high-risk PCI.

The study’s primary endpoint was all-cause in-hospital mortality. The authors found that the rate of all-cause in-hospital mortality for all patients was 2.4%. When looking at frailty status, the rates were 0.5% for nonfrail, 1.1% for prefrail, 3.3% for frail and 20.3% for the severely frail. They describe “a significant increase in adjusted risk for in-hospital mortality with increasing frailty,” regardless of bedside mortality score (p interaction<0.0001).

Among severely frail patients (2.2% of the study cohort), “strikingly high” mortality rates were observed for complex PCI procedures including cardiac arrest (44.2%), cardiogenic shock (51.0%), mechanical circulatory support (46.1%), chronic total occlusion (23.9%) and severe calcification (22.4%).

“These data showing the association of frailty with mortality risk should not justify withholding PCI, especially in acute coronary syndromes,” write the authors. “However, frailty status, even prefrailty, strongly influences procedural risk and should inform shared decision-making.”

In an accompanying editorial comment, John A. Dodson, MD, MPH, FACC, and Ashok Krishnaswami, MBBS, MAS, FACC, add that “to truly transform care for older adults, we must incorporate frailty testing into routine clinical practice, embedding it as a standard part of every assessment, much like we do for vital signs.”