Frailty and Cardiovascular Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Background: Frailty has a negative impact on cardiovascular care and resource utilization. Aims: We aimed to assess the impact of frailty on percutaneous coronary intervention (PCI) outcomes in a large cohort of patients undergoing PCI at a specialized referral center. Methods: This retrospective study included all patients undergoing PCI at our institution between 2018 and 2024. Patients were stratified by frailty using the clinical frailty scale (CFS). The primary outcome was in-hospital and 1-year all-cause mortality. Adjusted analyses were conducted with multivariable logistic regression and inverse probability of treatment weighting (IPTW) to evaluate associations between frailty and outcomes. Results: A total of 5297 patients were included, with 2210 (41.7%) classified as non-frail (CFS 1–3), 1801 (34.0%) as vulnerable (CFS 4), and 1286 (24.3%) as frail (CFS 5–9). Frail patients had a higher mean age, prevalence of women, and cardiovascular comorbidities. They also exhibited a higher procedural risk profile. In adjusted analyses (IPTW), in-hospital mortality was 0.3% in non-frail versus 0.4% in vulnerable versus 2.1% in frail patients (p < 0.001). The incidence of stroke and acute kidney injury was also highest in frail patients. At 1-year, frail patients had higher rates of all-cause mortality (p < 0.001), cardiovascular mortality (p = 0.041), and stroke (p < 0.001), compared to non-frail patients. Conclusion: Frailty is an independent predictor of in-hospital mortality and long-term adverse events in PCI patients, even after controlling for clinical and procedural characteristics, highlighting the need for routine frailty assessment to improve risk stratification and guide management.