Frailty in patients admitted to hospital for acute coronary syndrome: when, how and why?

Frailty is an issue of paramount importance for cardiologists,because of the aging of patients admitted to hospital for acute coronary syndrome(ACS)and the straight relationship between aging and frailty.Several tools have been provided in this setting,in order to objectively assess frailty status,but important questions are still unsolved.There are conflicting data about a unique definition of frailty in subjects with cardiovascular diseases,the timing to perform a frailty evaluation in the context of an acute myocardial infarction,the mean to assess frailty in these patients and the usefulness of the information derived from the frailty assessment.Frailty results from the analysis of several items and a multidomain evaluation including laboratory values,clinical data and physical performance assessment is required for a comprehensive frailty assessment.However,regardless of the frailty tool,the prevalence of frailty in older ACS patients is high and it could add important information to the decision-making process about invasive strategy,the multivessel disease management,dual antiplatelet therapy and secondary prevention programs.The present overview tries to summarize the current knowledge about the definition and prevalence of frailty in older adults admitted to hospital for ACS,suggesting how frailty assessment may improve the management of older ACS patients.

Fractional flow reserve: Current applications and overview of the available data

Flow fractional reserve(FFR) allows to evaluate the functional significance of coronary artery lesions, through the ratio of the mean coronary artery pressure after the stenosis to the mean aortic pressure duringmaximum hyperemia. The actual widely accepted cutoff value is 0.80. Below this value a coronary lesion is considered significant and therefore it requires invasive revascularization. Several studies [in particular Fractional Flow Reserve vs Angiography for Multivessel Evaluation 1(FAME-1) and FAME-2] have shown the relationship between FFR measurement and hard end-points(death, myocardial infarction, and urgent revascularization). Consequently, FFR evaluation represents the cornerstone in the decision-making in intermediate coronary lesions. Recent studies paved the way for further applications of FFR evaluation in complex and tricky clinical settings. In this paper, we perform an overview of the data regarding contemporary application of FFR. In particular, we review the use of FFR in: left main intermediate stenoses, serial stenoses, evaluation after stenting, guidance in coronary artery bypass surgery, and acute coronary syndrome. All the data presented in our overview confirm the essential role of FFR assessment in the daily clinical practice. The shift from "operator-dependent" to "FFR-dependent" evaluation in intermediate coronary artery stenosis is of paramount importance in order to improve the prognosis of our patients, through the discrimination of the functional role of every single coronary stenosis.