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OBJECTIVE Older adults with coronary artery disease(CAD)are at risk for frailty.However,little is known regarding trans-ition in frailty measures over time or its impact on outcomes.We sought to determine the association of temporal change in frailty with long-term outcome in older adults with CAD.METHODS We re-assessed for phenotypic frailty using the Fried index(0 = not frail;1-2 = pre-frail;≥3 frail)in a cohort of CAD patients≥65 years old at 2 time points 5 years apart.Factors associated with frailty worsening were assessed with scatter-plots and outcomes estimated using the Kaplan-Meier method.Cox models were used to assess the risk of worsening frailty on outcome.RESULTS There were 45 subjects that completed both baseline and 5-year Fried frailty assessment.Mean age was 74.6±5.9 and 30(67％)were men.Frailty incidence increased over time:baseline(3％frail,37％pre-frail);5 years(10％frail,40％pre-frail).Baseline factors were not predictors of worsening frailty score,while both slower walk time(r = 0.46;P = 0.004)and diminishing grip strength(r =-0.39;P = 0.01)were associated with worsening frailty transitions.In follow-up(median 5.2 years),long-term major adverse cardiac event(MACE)free survival(P = 0.12)or hospitalization(P = 0.98)was not different for those with worsen-ing frailty score(referent:improved/unchanged frailty).Frailty worsening had a trend towards increased risk of MACE(HR =1.86;95％CI:0.65-5.27,P= 0.25).CONCLUSIONS Frailty transitions,specifically,declines in walk time and grip strength,were strongly associated with worsening frailty score in a cohort of older adults with CAD than were baseline indices,though frailty change status was not in-dependently associated with MACE outcomes.