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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Frailty status and outcomes of percutaneous coronary intervention in elderly patients with non-ST-elevation myocardial infarction
Apurva Popat, Roopeessh Vempati, Lakshmi Sai Meghana Kodali, Alla Sai Santhosha Mrudula, Fadi Haddad, Akhil Jain, Geetha Krishnamoorthy, Param Sharma
Apurva Popat, Department of Cardiology, Marshfield Clinic, Marshfield, WI 5449, United States
Roopeessh Vempati, Alla Sai Santhosha Mrudula, Fadi Haddad, Geetha Krishnamoorthy, Internal Medicine, Trinity Health Oakland/Wayne State University School of Medicine, Pontiac, MI 48341, United States
Lakshmi Sai Meghana Kodali, Public Health & Health Sciences, University of Michigan, Flint, MI 48502, United States
Akhil Jain, Internal Medicine, University of Iowa Hospitals and Clinics, Iowa, IA 52242, United States
Param Sharma, Department of Cardiovascular Disease, Marshfield Clinic, Marshfield, WI 54449, United States
Co-first authors: Apurva Popat and Roopeessh Vempati.
Author contributions: Popat A conceptualized and designed the study, conducted statistical analysis, critically reviewed and revised the manuscript; Vempati R coordinated the statistical modelling and analysis, interpreted the data, and drafted the methods and results section including creation of tables and figure 1, critically reviewed and revised the manuscript; Kodali LSM contributed to literature review, and drafting of the discussion sections; Mrudula ASS contributed to the interpretation of results and drafted the introduction section; Haddad F assisted with clinical interpretation of findings and review of the manuscript; Jain A reviewed and edited the results and tables for accuracy and clarity, and is the corresponding author; Krishnamoorthy G supervised the study, provided expert guidance, reviewed critically and provided critical revisions of the manuscript; Sharma P provided expert guidance on study design, and final review of the manuscript. Popat A and Vempati R contributed equally to this work as co-first authors.
Institutional review board statement: As the NIS has de-identified national data, our Institutional Review Board exempted the study from a formal review and approval requirement. This article was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent statement: No written consent has been obtained from the patients, as no patient-identifiable data from the National Inpatient Sample database is included in this observational study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data is available. All data generated or analyzed during this study are included in this published article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Roopeessh Vempati, MD, Researcher, Internal Medicine, Trinity Health Oakland/Wayne State University School of Medicine, 44405 Woodward Avenue, Pontiac, MI 48341, United States.
roopeessh.vempati@gmail.com
Received: July 11, 2025
Revised: August 6, 2025
Accepted: September 17, 2025
Published online: October 26, 2025
Processing time: 105 Days and 16.5 Hours
BACKGROUND
Non-ST-elevation myocardial infarction (NSTEMI) is a prevalent acute coronary syndrome among the elderly, a population often underrepresented in clinical trials. Frailty, a marker of physiologic vulnerability, may influence the risks and benefits of percutaneous coronary intervention (PCI) in these patients.
AIM
To evaluate the impact of frailty status on in-hospital outcomes among patients aged ≥ 75 years with NSTEMI undergoing PCI.
METHODS
We conducted a retrospective cohort study using the 2021-2022 National Inpatient Sample to evaluate the impact of frailty on in-hospital outcomes among NSTEMI patients aged ≥ 75 years undergoing PCI. Patients were stratified into three frailty categories using the Hospital Frailty Risk Score. Multivariable logistic and generalized linear models with interaction terms assessed the association between frailty and clinical outcomes.
RESULTS
Among 456690 NSTEMI admissions, 37.95%, 50.71%, and 11.34% were categorized as low, intermediate, and high frailty, respectively. PCI use declined with increasing frailty (35.0% in low vs 7.5% in high; P < 0.001). Adjusted mortality was lower with PCI across all frailty levels [odds ratios (OR): 0.27 (low), 0.37 (intermediate), 0.43 (high); all P < 0.001]. However, the mortality benefit was attenuated with increasing frailty (interaction OR: 1.56 and 1.83 for intermediate and high vs low frailty; P < 0.001). Frailty was independently associated with higher odds of complications, including acute kidney injury, respiratory failure, delirium, and bleeding. PCI was associated with shorter hospital stays in low (-0.90 days) but longer in the high-frail category (+2.47 days; P < 0.001), and increasing frailty correlated with significantly higher hospital charges.
CONCLUSION
In elderly NSTEMI patients, PCI conferred a survival benefit across all frailty strata, although with a diminishing magnitude as frailty increased. Frailty correlated with increased complications and healthcare resource utilization.
Core Tip: This study evaluates how frailty affects the outcomes of percutaneous coronary intervention (PCI) in patients aged ≥ 75 years with non-ST-elevation myocardial infarction. Using the Hospital Frailty Risk Score, we found that PCI is associated with a reduction in in-hospital mortality across all frailty categories. However, the benefits of PCI decrease as frailty increases, while complications and healthcare utilization significantly rise. These findings emphasize the need for individualized treatment strategies. While frailty should not prevent PCI, it should be considered in shared decision-making to balance the survival benefits against the procedural risks and resource demands in this high-risk population.
