Ticagrelor or Clopidogrel After an Acute Coronary Syndrome in the Elderly: A Propensity Score Matching Analysis from 16,653 Patients Treated with PCI Included in Two Large Multinational Registries

[EN] Purpose Higher risk of bleeding with ticagrelor over clopidogrel in elderly patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) has been suggested. We assessed the incidence of major bleedings (MB), reinfarction (re-MI), and all-cause death to eval...

Descripción completa

Detalles Bibliográficos
Autores: Bianco, Matteo, Careggio, Alessandro, Biolè, Carlo Alberto, Quadri, Giorgio, Quirós Carretero, Alicia, Raposeiras Roubin, Sergio, Abu-Assi, Emad, Kinnaird, Tim, Ariza Solè, Albert, Liebetrau, Christoph, Manzano Fernàndez, Sergio, Boccuzzi, Giacomo, Henriques, Jose PS, Templin, Christian, Wilton, Stephen B., Velicki, Lazar, Correia, Luis, Rognoni, Andrea, Fabrizio, Ugo, Nunez Gil, Ivàn, Fujii, Toshiharu, Durante, Alessandro, Xiantao, Song, Kawaji, Tetsuma, Alexopoulos, Dimitrios, Giacobbe, Federico, Huczek, Zenon, González Juanatey, José Ramón, Nie, Shao-Ping, Kawashiri, Masa-Aki, Morbiducci, Umberto, Domínguez Rodríguez, Alberto, Destefanis, Paola, Luciano, Alessia, Ferrari, Gaetano Maria de, Varbella, Ferdinando, Montagna, Laura, D’Ascenzo, Fabrizio, Cerrato, Enrico
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2021
País:España
Institución:Universidad de León
Repositorio:BULERIA. Repositorio Institucional de la Universidad de León
OAI Identifier:oai:buleria.unileon.es:10612/26677
Acceso en línea:https://hdl.handle.net/10612/26677
Access Level:acceso abierto
Palabra clave:Matemáticas
Acute coronary syndrome
Bleeding
Dual antiplatelet therapy
Elderly
Ticagrelor
3205.01 Cardiología
12 Matemáticas
Descripción
Sumario:[EN] Purpose Higher risk of bleeding with ticagrelor over clopidogrel in elderly patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) has been suggested. We assessed the incidence of major bleedings (MB), reinfarction (re-MI), and all-cause death to evaluate safety and efficacy of ticagrelor versus clopidogrel in such population. Methods Real-world registries RENAMI and BleeMACS were merged. The pooled cohort was divided into two groups, clopidogrel versus ticagrelor. Statistical analysis considered patients <75 versus ≥75 years old. Endpoints were BARC 3–5 MB, re-MI, and all-cause death at 1-year follow-up. The study included 16,653 patients (13,153 < 75 and 3500 ≥ 75 years). Ticagrelor was underused in elderly patients (16.3% versus 20.8%, P < 0.001). Using propensity score matching (PSM), two treatment groups of 1566 patients were included in the final analysis. Results Ticagrelor was able to prevent re-MI (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.2–0.6; P < 0.001) and all-cause death (HR, 0.60; 95% CI, 0.4–0.9; P = 0.026) irrespective of age. In patients ≥75 years, ticagrelor reduced all-cause death (HR, 0.32; 95% CI, 0.1–0.8; P = 0.012) and re-MI (HR, 0.25; 95% CI, 0.1–1.1, P = 0.072). Moreover, even with the limit of the low number of events, ticagrelor did not significantly increase the incidence of MB (HR, 1.49; 95% CI, 0.70–3.0; P = 0.257). At multiple Cox regression, age (HR, 1.03; 95% CI, 1.02–1.05; P < 0.001) resulted an independent risk factor for bleeding. Conclusion In our study, reflecting the results from two large retrospective, real-world registries, Ticagrelor did not significantly increase MB compared with clopidogrel in elderly patients with ACS treated with PCI, while significantly improving 1-year survival. Further studies on elderly patients are suggested.

Similares en LA Referencia