27 The association of frailty and coronary artery disease burden in older patients with non-st elevation acute coronary syndrome
Bibliographic record
Abstract
Introduction Frailty is common in older patients who present with Acute Coronary Syndrome (ACS). However, its association with coronary disease complexity measured by Syntax and British Cardiovascular Intervention Society jeopardy score (BCIS JS) is not known. Methods 276 patients ≥75 years of age, admitted for invasive management of Non-ST Elevation ACS (NSTEACS), were enrolled into a 2 centre prospective observational study (ICON1 study-NCT01933581). Frailty was assessed using the Fried criteria (score 0 robust, 1 or 2 pre-frail and ≥3 is frail). Syntax 1.0 calculator, BCIS algorithm and Global Registry of Acute Coronary Events (GRACE) 2.0 calculator were used to calculate scores. Procedure complication includes dissection, distal embolization, abrupt closure, thrombus, perforation and loss of side branch evaluated at Newcastle angiographic core lab. Results Frail patients tend to have higher GRACE 2.0 scores (124.0±13.7 vs 131.3±19.7 vs 136.0±19.5, p=0.008). With increasing frailty, there was a non-significant increase in the proportion with SYNTAX score greater than 22 (20.8% vs 27.5% vs 31.5%, p=0.436) and BCIS JS ≥6 (56.0% vs 61.6% vs 64.1%, p=0.651). Frail patients were more likely to have moderate to severe calcification (34% vs 44.8% vs 62.0%, p=0.005). Overall procedure complication rate is low at 4.6%, with no difference among frailty groups (2.3% vs 4.5% vs 6.3%, p=0.76). Abstract 27 Table 1 Baseline characteristics by fried frailty status Variables Overall n= 276 Robust n= 50 Pre-frail n= 147 Frail n= 79 P value Age (mean±SD) years 81.1±4.1 80.0±3.8 81.2±4.1 81.7±4.2 0.076 Male gender n(%) 165 (59.8) 37 (74.0) 90 (61.2) 38 (48.1) 0.012 Hypertension n(%) 202 (73.5) 35 (70.0) 103 (70.5) 64 (81.0) 0.197 Diabetes n(%) 70 (25.5) 7 (14.0) 40 (27.4) 23 (29.1) 0.116 Smoking history n(%) 159 (57.6) 31 (62) 75 (51) 53 (67.1) 0.052 Hypercholesterolaemia n(%) 159 (57.8) 29 (58.0) 83 (56.8) 47 (59.5) 0.929 Family history of IHD n(%) 78 (28.7) 12 (25.0) 41 (28.3) 25 (31.6) 0.716 Previous MI n(%) 92 (33.3) 11 (22.0) 45 (30.6) 36 (45.6) 0.013 Cerebrovascular disease n(%) 46 (16.7) 3 (6.0) 21 (14.3) 22 (27.8) 0.003 Congestive cardiac failure n(%) 24 (8.7) 1 (2.0) 10 (6.8) 13 (16.5) 0.009 NYHA class III/IV n(%) 53 (19.2) 4 (8.0) 24 (16.3) 25 (31.6) 0.002 CCS class III or IV n(%) 39 (14.1) 6 (12.0) 19 (12.9) 14 (17.7) 0.548 BMI- body mass index, CCS- Canadian cardiovascular society, IHD- ischaemic heart disease, NYHA- New York heart association, PCI- percutaneous coronary intervention, SD- standard deviation, MI- myocardial infarction Conclusions Frail older patients have higher GRACE score and more severe calcification in the coronary arteries. However, the complexity of coronary disease is not significantly different in this patient group.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".