Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2024; 12(1): 107-118
Published online Jan 6, 2024. doi: 10.12998/wjcc.v12.i1.107
Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis
Shi-Shi Wang, Wang-Hao Liu
Shi-Shi Wang, Department of Emergency Medicine, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
Wang-Hao Liu, Department of Geriatrics, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
Author contributions: Wang SS and Liu WH designed the research; Wang SS and Liu WH performed the research; Wang SS analyzed the data; Wang SS and Liu WH wrote the paper.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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:
Corresponding author: Wang-Hao Liu, MD, Professor, Research Scientist, Department of Geriatrics, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, No. 2088 Tiaoxi East Road, Wuxing District, Huzhou 313000, Zhejiang Province, China.
Received: October 27, 2023
Peer-review started: October 27, 2023
First decision: November 21, 2023
Revised: November 30, 2023
Accepted: December 15, 2023
Article in press: December 15, 2023
Published online: January 6, 2024

Frailty is a common condition in elderly patients who receive percutaneous coronary intervention (PCI). However, how frailty affects clinical outcomes in this group is unclear.


To assess the link between frailty and the outcomes, such as in-hospital complications, post-procedural complications, and mortality, in elderly patients post-PCI.


The PubMed/MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were screened for publications up to August 2023. The primary outcomes assessed were in-hospital and all-cause mortality, major adverse cardiovascular events (MACEs), and major bleeding. The Newcastle-Ottawa Scale was used for quality assessment.


Twenty-one studies with 739693 elderly patients undergoing PCI were included. Frailty was consistently associated with adverse outcomes. Frail patients had significantly higher risks of in-hospital mortality [risk ratio: 3.45, 95% confidence interval (95%CI): 1.90-6.25], all-cause mortality [hazard ratio (HR): 2.08, 95%CI: 1.78-2.43], MACEs (HR: 2.92, 95%CI: 1.85-4.60), and major bleeding (HR: 4.60, 95%CI: 2.89-7.32) compared to non-frail patients.


Frailty is a pivotal determinant in the prediction of risk of mortality, development of MACEs, and major bleeding in elderly individuals undergoing percutaneous coronary intervention.

Keywords: Frailty, Elderly, Percutaneous coronary intervention, Systematic review, Meta-analysis

Core Tip: This comprehensive meta-analysis elucidates the significant impact of frailty on outcomes in elderly patients undergoing percutaneous coronary intervention (PCI). The study underscores the consistent association between frailty and heightened risks of in-hospital mortality, all-cause mortality, major adverse cardiovascular events, and major bleeding. The convergence of results across diverse study designs, patient populations, and methodological approaches underscores the robustness of these findings. Recognizing frailty as a potent predictor allows for tailored care plans, emphasizing the need for standardized frailty assessment in the pre-PCI evaluation of elderly patients.