Sex-differential effect of frailty on long-termmortality in elderly patients after an acute coronary syndrome

Background The potential sex-differential effect of frailty in patients with acute coronary syndromes (ACS) has not been well-evaluated. We sought to examine the sex-differential association between frailty status on long-term mortality in elderly patients with an ACS. Methods and results This is a prospective observational single-center study that included 488 elderly patients (>65 years) hospitalized for ACS who survived the index hospitalization. Multivariate Cox regression was used to determine the association among the exposures (interaction of sex with Fried score and sex with Fried ≥ 3) and all-cause mortality. The mean age of the sample was 78 ± 7 years; 41% were female and the median Fried score was higher in women [3 (2–3) vs. 2 (1–2) points, p < 0.001]. At a median follow-up of 3.12 years (IQR:1.38–5.13), 182 deaths (37.3%) were registered. The association of Fried ≥ 3 with mortality varied across sex (p-value for interaction = 0.022). In males, Fried ≥ 3 was independently associated with all-cause death (HR = 1.89; CI 95%:1.25–2.85, p = 0.003). However, it showed a neutral effect on women (HR = 0.92; CI 95%:0.57–1.49, p = 0.726). Conclusions In this work, we found that the frailty status assessed by Fried score was independently associated with mortality in elderly males but not in females with ACS