Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥85 years) with ST-elevation myocardial infarction

Background: The optimal treatment strategies for acute ST-elevation myocardial infarction (STEMI) in older patients are unclear because of the high risk of mortality in this population. Hypoalbuminemia, frailty, and body mass index (BMI) have been reported to worsen the prognosis of some older patients with cardiovascular disease, but the specific impact of these factors on the prognosis after STEMI is poorly understood. The aim of this study was to investigate the impact of these factors on early outcomes in patients aged >= 85 years with acute STEMI. Methods: Sixty-two consecutive eligible patients aged >= 85 years (mean age, 88.1 +/- 2.5 years; age range, 85-94 years; female, 41.9%; primary percutaneous coronary intervention, 67.7%) who were admitted to our hospital with STEMI were retrospectively reviewed. Baseline patient characteristics, echocardiographic, electrocardiographic, and laboratory findings, and the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) score were assessed. The primary endpoint was in-hospital mortality and the secondary endpoint was failure of discharge to home. Independent baseline variables with a p-value of <0.15 in the univariate analyses were included in the multivariate analyses. Results: Multivariate analysis identified a higher baseline serum troponin I level [p = 0.046; odds ratio (OR): 1.02], lower baseline albumin level (p = 0.035, OR: 0.16), and CSHA-CFS score >= 6 (p = 0.028, OR: 6.38) as independent predictors of in-hospital mortality. Lower BMI (p < 0.001, OR: 0.49) and CSHA-CFS frailty score >= 6 (p = 0.002, OR: 16.69) were identified as independent predictors of failure of discharge to home. Conclusions: These findings indicate that the serum albumin level, CSHA-CFS score, and BMI, in addition to serum troponin I level, have an impact on the early prognosis of older patients with STEMI. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.