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Effect of Physical Disability on Mortality in Elderly Patients of ≥80 Years of Age Undergoing Percutaneous Coronary Intervention

      Functional decrease has been linked with adverse events in different clinical contexts. The predictive role of activity of daily living status as assessed by the Barthel index (BI) in elderly patients who underwent percutaneous coronary intervention (PCI) has not been investigated, yet. In this study, a total of 616 patients (≥80 years) who underwent PCI between January 2009 and December 2014 and with available activity of daily living data on admission were stratified according to BI (low BI <85, intermediate BI 85 to 95, high BI 100). The primary end point was all-cause mortality at a total follow-up of 442 days (interquartile range 47 to 1243). Of the 616 patients, 178 (29%), 128 (21%), and 310 (50%) were in the low, the intermediate, and the high BI groups, respectively. All-cause mortality was 10%, 13%, and 5% in the low, the intermediate, and the high BI groups, respectively (log-rank p <0.001). Belonging to the high BI group was associated with a reduced risk of all-cause mortality (hazard ratio 0.35, 95% confidence interval 0.18 to 0.69, p = 0.002), and associations remained significant after multivariable adjustments (adjusted hazard ratio 0.34, 95% confidence interval 0.13 to 0.93, p = 0.04). Functional capacity was identified as independent predictor of survival in a large cohort of patients who underwent PCI. In conclusion, activities of daily living should be incorporated into the risk stratification of elderly patients with coronary artery disease.
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      References

        • Gale C.P.
        • Cattle B.A.
        • Woolston A.
        • Baxter P.D.
        • West T.H.
        • Simms A.D.
        • Blaxill J.
        • Greenwood D.C.
        • Fox K.A.
        • West R.M.
        Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The Myocardial Ischaemia National Audit Project 2003–2010.
        Eur Heart J. 2012; 33: 630-639
        • Smith L.G.
        • Herlitz J.
        • Karlsson T.
        • Berger A.K.
        • Luepker R.V.
        International comparison of treatment and long-term outcomes for acute myocardial infarction in the elderly: Minneapolis/St. Paul, MN, USA and Goteborg, Sweden.
        Eur Heart J. 2013; 34: 3191-3197
        • Avezum A.
        • Makdisse M.
        • Spencer F.
        • Gore J.M.
        • Fox K.A.
        • Montalescot G.
        • Eagle K.A.
        • White K.
        • Mehta R.H.
        • Knobel E.
        • Collet J.P.
        • GRACE Investigators
        Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE).
        Am Heart J. 2005; 149: 67-73
        • Zaman M.J.
        • Stirling S.
        • Shepstone L.
        • Ryding A.
        • Flather M.
        • Bachmann M.
        • Myint P.K.
        The association between older age and receipt of care and outcomes in patients with acute coronary syndromes: a cohort study of the Myocardial Ischaemia National Audit Project (MINAP).
        Eur Heart J. 2014; 35: 1551-1558
        • Matsuzawa Y.
        • Konishi M.
        • Akiyama E.
        • Suzuki H.
        • Nakayama N.
        • Kiyokuni M.
        • Sumita S.
        • Ebina T.
        • Kosuge M.
        • Hibi K.
        • Tsukahara K.
        • Iwahashi N.
        • Endo M.
        • Maejima N.
        • Saka K.
        • Hashiba K.
        • Okada K.
        • Taguri M.
        • Morita S.
        • Sugiyama S.
        • Ogawa H.
        • Sashika H.
        • Umemura S.
        • Kimura K.
        Association between gait speed as a measure of frailty and risk of cardiovascular events after myocardial infarction.
        J Am Coll Cardiol. 2013; 61: 1964-1972
        • Sanchis J.
        • Bonanad C.
        • Ruiz V.
        • Fernandez J.
        • Garcia-Blas S.
        • Mainar L.
        • Ventura S.
        • Rodriguez-Borja E.
        • Chorro F.J.
        • Hermenegildo C.
        • Bertomeu-Gonzalez V.
        • Nunez E.
        • Nunez J.
        Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome.
        Am Heart J. 2014; 168: 784-791
        • Mahoney F.I.
        • Barthel D.W.
        Functional evaluation: the Barthel index.
        Md State Med J. 1965; 14: 61-65
        • Sulter G.
        • Steen C.
        • De Keyser J.
        Use of the Barthel index and modified Rankin scale in acute stroke trials.
        Stroke. 1999; 30: 1538-1541
        • Goodbrand J.A.
        • Hughes L.D.
        • Cochrane L.
        • Donnan P.T.
        • McGilchrist M.
        • Frost H.
        • McMurdo M.E.
        • Witham M.D.
        Association between bisphosphonate therapy and outcomes from rehabilitation in older people.
        Arch Gerontol Geriatr. 2017; 70: 195-200
        • Tarro Genta F.
        • Tidu M.
        • Bouslenko Z.
        • Bertolin F.
        • Salvetti I.
        • Comazzi F.
        • Giannuzzi P.
        Cardiac rehabilitation after transcatheter aortic valve implantation compared to patients after valve replacement.
        J Cardiovasc Med (Hagerstown). 2017; 18: 114-120
        • Tanaka R.
        • Umehara T.
        • Fujimura T.
        • Ozawa J.
        Clinical prediction rule for declines in activities of daily living at 6 months after surgery for hip fracture repair.
        Arch Phys Med Rehabil. 2016; 97: 2076-2084
        • Montalescot G.
        • Sechtem U.
        • Achenbach S.
        • Andreotti F.
        • Arden C.
        • Budaj A.
        • Bugiardini R.
        • Crea F.
        • Cuisset T.
        • Di Mario C.
        • Ferreira J.R.
        • Gersh B.J.
        • Gitt A.K.
        • Hulot J.S.
        • Marx N.
        • Opie L.H.
        • Pfisterer M.
        • Prescott E.
        • Ruschitzka F.
        • Sabate M.
        • Senior R.
        • Taggart D.P.
        • van der Wall E.E.
        • Vrints C.J.
        • Zamorano J.L.
        • Achenbach S.
        • Baumgartner H.
        • Bax J.J.
        • Bueno H.
        • Dean V.
        • Deaton C.
        • Erol C.
        • Fagard R.
        • Ferrari R.
        • Hasdai D.
        • Hoes A.W.
        • Kirchhof P.
        • Knuuti J.
        • Kolh P.
        • Lancellotti P.
        • Linhart A.
        • Nihoyannopoulos P.
        • Piepoli M.F.
        • Ponikowski P.
        • Sirnes P.A.
        • Tamargo J.L.
        • Tendera M.
        • Torbicki A.
        • Wijns W.
        • Windecker S.
        • Document R.
        • Knuuti J.
        • Valgimigli M.
        • Bueno H.
        • Claeys M.J.
        • Donner-Banzhoff N.
        • Erol C.
        • Frank H.
        • Funck-Brentano C.
        • Gaemperli O.
        • Gonzalez-Juanatey J.R.
        • Hamilos M.
        • Hasdai D.
        • Husted S.
        • James S.K.
        • Kervinen K.
        • Kolh P.
        • Kristensen S.D.
        • Lancellotti P.
        • Maggioni A.P.
        • Piepoli M.F.
        • Pries A.R.
        • Romeo F.
        • Ryden L.
        • Simoons M.L.
        • Sirnes P.A.
        • Steg P.G.
        • Timmis A.
        • Wijns W.
        • Windecker S.
        • Yildirir A.
        • Zamorano J.L.
        • ESC Committee for Practice Guidelines
        2013 ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology.
        Eur Heart J. 2013; 34: 2949-3003
        • Roffi M.
        • Patrono C.
        • Collet J.P.
        • Mueller C.
        • Valgimigli M.
        • Andreotti F.
        • Bax J.J.
        • Borger M.A.
        • Brotons C.
        • Chew D.P.
        • Gencer B.
        • Hasenfuss G.
        • Kjeldsen K.
        • Lancellotti P.
        • Landmesser U.
        • Mehilli J.
        • Mukherjee D.
        • Storey R.F.
        • Windecker S.
        • Baumgartner H.
        • Gaemperli O.
        • Achenbach S.
        • Agewall S.
        • Badimon L.
        • Baigent C.
        • Bueno H.
        • Bugiardini R.
        • Carerj S.
        • Casselman F.
        • Cuisset T.
        • Erol C.
        • Fitzsimons D.
        • Halle M.
        • Hamm C.
        • Hildick-Smith D.
        • Huber K.
        • Iliodromitis E.
        • James S.
        • Lewis B.S.
        • Lip G.Y.
        • Piepoli M.F.
        • Richter D.
        • Rosemann T.
        • Sechtem U.
        • Steg P.G.
        • Vrints C.
        • Luis Zamorano J.
        2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2016; 37: 267-315
        • Steg P.G.
        • James S.K.
        • Atar D.
        • Badano L.P.
        • Blomstrom-Lundqvist C.
        • Borger M.A.
        • Di Mario C.
        • Dickstein K.
        • Ducrocq G.
        • Fernandez-Aviles F.
        • Gershlick A.H.
        • Giannuzzi P.
        • Halvorsen S.
        • Huber K.
        • Juni P.
        • Kastrati A.
        • Knuuti J.
        • Lenzen M.J.
        • Mahaffey K.W.
        • Valgimigli M.
        • van't Hof A.
        • Widimsky P.
        • Zahger D.
        ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.
        Eur Heart J. 2012; 33: 2569-2619
        • Higuchi S.
        • Kabeya Y.
        • Matsushita K.
        • Taguchi H.
        • Ishiguro H.
        • Kohshoh H.
        • Yoshino H.
        Barthel index as a predictor of 1-year mortality in very elderly patients who underwent percutaneous coronary intervention for acute coronary syndrome: better activities of daily living, longer life.
        Clin Cardiol. 2016; 39: 83-89
        • The GUSTO Investigators
        An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction.
        New Engl J Med. 1993; 329: 673-682
        • Schoenenberger A.W.
        • Radovanovic D.
        • Windecker S.
        • Iglesias J.F.
        • Pedrazzini G.
        • Stuck A.E.
        • Erne P.
        • AMIS Plus Investigators
        Temporal trends in the treatment and outcomes of elderly patients with acute coronary syndrome.
        Eur Heart J. 2016; 37: 1304-1311
        • Toma A.
        • Gebhard C.
        • Gick M.
        • Ademaj F.
        • Stahli B.E.
        • Mashayekhi K.
        • Ferenc M.
        • Neumann F.J.
        • Buettner H.J.
        Survival after Percutaneous Coronary Intervention for chronic total occlusion in elderly patients.
        EuroIntervention. 2016; 13: e228-e235
        • Johnman C.
        • Oldroyd K.G.
        • Mackay D.F.
        • Slack R.
        • Pell A.C.
        • Flapan A.D.
        • Jennings K.P.
        • Eteiba H.
        • Irving J.
        • Pell J.P.
        Percutaneous coronary intervention in the elderly: changes in case-mix and periprocedural outcomes in 31,758 patients treated between 2000 and 2007.
        Circ Cardiovasc Interv. 2010; 3: 341-345
        • Corrao S.
        • Santalucia P.
        • Argano C.
        • Djade C.D.
        • Barone E.
        • Tettamanti M.
        • Pasina L.
        • Franchi C.
        • Kamal Eldin T.
        • Marengoni A.
        • Salerno F.
        • Marcucci M.
        • Mannucci P.M.
        • Nobili A.
        • REPOSI Investigators
        Gender-differences in disease distribution and outcome in hospitalized elderly: data from the REPOSI study.
        Eur J Intern Med. 2014; 25: 617-623
        • Alexander K.P.
        • Newby L.K.
        • Cannon C.P.
        • Armstrong P.W.
        • Gibler W.B.
        • Rich M.W.
        • Van de Werf F.
        • White H.D.
        • Weaver W.D.
        • Naylor M.D.
        • Gore J.M.
        • Krumholz H.M.
        • Ohman E.M.
        • American Heart Association Council on Clinical Cardiology
        • Society of Geriatric Cardiology
        Acute coronary care in the elderly, part I: non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology.
        Circulation. 2007; 115: 2549-2569
        • Amann U.
        • Kirchberger I.
        • Heier M.
        • von Scheidt W.
        • Kuch B.
        • Peters A.
        • Meisinger C.
        Acute myocardial infarction in the elderly: treatment strategies and 28-day-case fatality from the MONICA/KORA myocardial infarction registry.
        Catheter Cardiovasc Interv. 2016; 87: 680-688
        • Plakht Y.
        • Shiyovich A.
        • Gilutz H.
        Predictors of long-term (10-year) mortality postmyocardial infarction: age-related differences. Soroka Acute Myocardial Infarction (SAMI) Project.
        J Cardiol. 2015; 65: 216-223
        • Nunez J.
        • Ruiz V.
        • Bonanad C.
        • Minana G.
        • Garcia-Blas S.
        • Valero E.
        • Nunez E.
        • Sanchis J.
        Percutaneous coronary intervention and recurrent hospitalizations in elderly patients with non ST-segment acute coronary syndrome: the role of frailty.
        Int J Cardiol. 2017; 228: 456-458
        • Rodrigues P.
        • Santos M.
        • Sousa M.J.
        • Brochado B.
        • Anjo D.
        • Barreira A.
        • Preza-Fernandes J.
        • Palma P.
        • Viamonte S.
        • Torres S.
        Cardiac rehabilitation after an acute coronary syndrome: the impact in elderly patients.
        Cardiology. 2015; 131: 177-185
        • Suaya J.A.
        • Stason W.B.
        • Ades P.A.
        • Normand S.L.
        • Shepard D.S.
        Cardiac rehabilitation and survival in older coronary patients.
        J Am Coll Cardiol . 2009; 54: 25-33