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

被引：13

作者：

Bianco, Matteo ^{[1
]}

Careggio, Alessandro ^{[1
]}

Biole, Carlo Alberto ^{[1
]}

Quadri, Giorgio ^{[2
,3
]}

Quiros, Alicia ^{[4
]}

Raposeiras-Roubin, Sergio ^{[5
]}

Abu-Assi, Emad ^{[5
]}

Kinnaird, Tim ^{[6
]}

Ariza-Sole, Albert ^{[7
]}

Liebetrau, Christoph ^{[8
]}

Manzano-Fernandez, Sergio ^{[9
]}

Boccuzzi, Giacomo ^{[10
]}

Henriques, Jose P. S. ^{[11
]}

Spirito, Amanda ^{[1
]}

Templin, Christian ^{[12
]}

Wilton, Stephen B. ^{[13
]}

Velicki, Lazar ^{[14
,15
]}

Correia, Luis ^{[16
]}

Rognoni, Andrea ^{[17
,18
]}

Ugo, Fabrizio ^{[19
]}

Nunez-Gil, Ivan ^{[20
]}

Fujii, Toshiharu ^{[21
]}

Durante, Alessandro ^{[22
]}

Song, Xiantao ^{[23
,24
]}

Kawaji, Tetsuma ^{[25
]}

Alexopoulos, Dimitrios ^{[26
]}

Huczek, Zenon ^{[27
]}

Juanatey, Jose Ramon Gonzalez ^{[28
]}

Nie, Shao-Ping ^{[29
]}

Kawashiri, Masa-Aki ^{[30
]}

Morbiducci, Umberto ^{[31
]}

Dominguez-Rodriguez, Alberto ^{[32
]}

Destefanis, Paola ^{[1
]}

Luciano, Alessia ^{[1
]}

De Ferrari, Gaetano Maria ^{[33
]}

Varbella, Ferdinando ^{[2
,3
]}

Montagna, Laura ^{[1
]}

D'Ascenzo, Fabrizio ^{[33
]}

Cerrato, Enrico ^{[2
,3
]}

机构：

[1] San Luigi Gonzaga Univ Hosp, Cardiol Div, Turin, Italy

[2] San Luigi Gonzaga Univ Hosp, Intervent Cardiol Unit, Turin, Italy

[3] Rivoli Infermi Hosp, Turin, Italy

[4] Univ Leon, Dept Stat, Leon, Spain

[5] Univ Hosp Alvaro Cunqueiro, Dept Cardiol, Vigo, Pontevedra, Spain

[6] Univ Hosp Wales, Cardiol Dept, Cardiff, Wales

[7] Univ Hosp Bellvitge, Dept Cardiol, Barcelona, Spain

[8] Kerckhoff Heart & Thorax Ctr, Dept Cardiol, Bad Nauheim, Germany

[9] Univ Hosp Virgen Arrtixaca, Dept Cardiol, Murcia, Spain

[10] SG Bosco Hosp, Dept Cardiol, Turin, Italy

[11] Univ Amsterdam, Acad Med Ctr, Dept Cardiol, Amsterdam, Netherlands

[12] Univ Hosp Zurich, Univ Heart Ctr, Dept Cardiol, Zurich, Switzerland

[13] Libin Cardiovasc Inst Alberta, Calgary, AB, Canada

[14] Univ Novi Sad, Fac Med, Novi Sad, Serbia

[15] Inst Cardiovasc Dis Vojvodina, Sremska Kamenica, Serbia

[16] Med & Publ Hlth Sch Bahia, Dept Cardiol, Salvador, BA, Brazil

[17] AOU Maggiore Carita, Coronary Care Unit, Novara, Italy

[18] AOU Maggiore Carita, Catheterizat Lab, Novara, Italy

[19] Presidio Osped St Andrea Vercelli, Cardiol Div, Vercelli, Italy

[20] Hosp Clin Univ San Carlos, Cardiovasc Inst, Intervent Cardiol, Madrid, Spain

[21] Tokai Univ, Dept Cardiol, Div Cardiovasc Med, Sch Med, Isehara, Kanagawa, Japan

[22] Osped Valduce, UO Cardiol, Como, Italy

[23] Capital Med Univ, Beijing Anzhen Hosp, Dept Cardiol, Beijing, Peoples R China

[24] Beijing Inst Heart Lung & Blood Vessel Dis, Beijing, Peoples R China

[25] Mitsubishi Kyoto Hosp, Dept Cardiol, Kyoto, Japan

[26] Patras Univ Hosp, Dept Cardiol, Patras, Greece

[27] Med Univ Warsaw, Dept Cardiol, Warsaw, Poland

[28] Hosp Clin Univ Santiago de Compostela, Serv Hemodinam, Santiago De Compostela, A Coruna, Spain

[29] Inst Heart Lung & Blood Vessel Dis, Beijing, Peoples R China

[30] Kanazawa Univ, Dept Cardiovasc Med, Grad Sch Med Sci, Kanazawa, Ishikawa, Japan

[31] Politecn Torino, PolitoBIOMed Lab, Dept Mech & Aerosp Engn, Turin, Italy

[32] Hosp Univ Canarias, Dept Cardiol, La Cuesta, Santa Cruz De T, Spain

[33] Univ Turin, Citta Salute & Sci Torino Hosp, Dept Med Sci, Cardiol Div, Turin, Italy

来源：

CARDIOVASCULAR DRUGS AND THERAPY | 2021年 / 35卷 / 06期

关键词：

Acute coronary syndrome; Bleeding; Dual antiplatelet therapy; Elderly; Ticagrelor; DUAL ANTIPLATELET THERAPY; ELEVATION MYOCARDIAL-INFARCTION; FOCUSED UPDATE; OPEN-LABEL; MONOTHERAPY; INHIBITORS; OUTCOMES; DISEASE; OLDER;

D O I：

10.1007/s10557-021-07213-y

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1171 / 1182

页数：12

共 29 条

[1] Derivation, Validation, and Prognostic Utility of a Prediction Rule for Nonresponse to Clopidogrel The ABCD-GENE Score [J].

Angiolillo, Dominick J. ;

Capodanno, Davide ;

Danchin, Nicolas ;

Simon, Tabassome ;

Bergmeijer, Thomas O. ;

ten Berg, Jurrien M. ;

Sibbing, Dirk ;

Price, Matthew J. .

JACC-CARDIOVASCULAR INTERVENTIONS, 2020, 13 (05) :606-617

[2] P2Y12 inhibitors monotherapy after short course of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized clinical trials including 29 089 patients [J].

Bianco, Matteo ;

Careggio, Alessandro ;

Destefanis, Paola ;

Luciano, Alessia ;

Perrelli, Maria Giulia ;

Quadri, Giorgio ;

Rossini, Roberta ;

Campo, Gianluca ;

Vizzari, Giampiero ;

D'Ascenzo, Fabrizio ;

Anselmino, Matteo ;

Biondi-Zoccai, Giuseppe ;

Ibanez, Borja ;

Montagna, Laura ;

Varbella, Ferdinando ;

Cerrato, Enrico .

EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY, 2021, 7 (03) :196-205

[3] Antithrombotic Therapy in the Elderly [J].

Capodanno, Davide ;

Angiolillo, Dominick J. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2010, 56 (21) :1683-1692

[4] Antithrombotic Management of Elderly Patients With Coronary Artery Disease [J].

Capranzano, Piera ;

Angiolillo, Dominick J. .

JACC-CARDIOVASCULAR INTERVENTIONS, 2020, 14 (07) :723-738

[5] Tailoring P2Y12 Inhibiting Therapy in Elderly Patients With Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention [J].

Capranzano, Piera ;

Angiolillo, Dominick J. .

JOURNAL OF THE AMERICAN HEART ASSOCIATION, 2019, 8 (18)

[6]

Collet JP, 2021, REV ESP CARDIOL, V74, DOI [10.1016/j.rec.2021.05.002, 10.1093/eurheartj/ehaa575]

[7] Average daily ischemic versus bleeding risk in patients with ACS undergoing PCI: Insights from the BleeMACS and RENAMI registries [J].

D'Ascenzo, Fabrizio ;

Biole, Carloalberto ;

Raposeiras-Roubin, Sergio ;

Gaido, Federico ;

Abu-Assi, Emad ;

Kinnaird, Tim ;

Ariza-Sole, Albert ;

Liebetrau, Christoph ;

Manzano-Fernandez, Sergio ;

Boccuzzi, Giacomo ;

Simao Henriques, Jose Paulo ;

Templin, Christian ;

Wilton, Stephen B. ;

Omede, Pierluigi ;

Velicki, Lazar ;

Xanthopoulou, Ioanna ;

Correia, Luis ;

Cerrato, Enrico ;

Rognoni, Andrea ;

Fabrizio, Ugo ;

Nunez-Gil, Ivan ;

Montabone, Andrea ;

Taha, Salma ;

Fujii, Toshiharu ;

Durante, Alessandro ;

Song, Xiantao ;

Gili, Sebastiano ;

Magnani, Giulia ;

Autelli, Michele ;

Bongiovanni, Federica ;

Grosso, Alberto ;

Kawaji, Tetsuma ;

Flores Blanco, Pedro ;

Garay, Alberto ;

Quadri, Giorgio ;

Alexopoulos, Dimitrios ;

Caneiro Queija, Berenice ;

Huczek, Zenon ;

Paz, Rafael Cobas ;

Ramon Gonzalez-Juanatey, Jose ;

Cespon Fernandez, Maria ;

Nie, Shao-Ping ;

Munoz Pousa, Isabel ;

Kawashiri, Masa-aki ;

Rettegno, Sara ;

Gallo, Diego ;

Morbiducci, Umberto ;

Conrotto, Federico ;

Dominguez-Rodriguez, Alberto ;

Valdes, Mariano .

AMERICAN HEART JOURNAL, 2020, 220 :108-115

[8] BleeMACS: rationale and design of the study [J].

D'Ascenzo, Fabrizio ;

Abu-Assi, Emad ;

Raposeiras-Roubin, Sergio ;

Simao Henriques, Jose Paulo ;

Saucedo, Jorge ;

Ramon Gonzalez-Juanatey, Jose ;

Wilton, Stephen B. ;

Kikkert, Wouter J. ;

Nunez-Gil, Ivan ;

Ariza-Sole, Albert ;

Song, Xiantao ;

Alexopoulos, Dimitrios ;

Liebetrau, Christoph ;

Kawaji, Tetsuma ;

Moretti, Claudio ;

Huczek, Zenon ;

Nie, Shao-Ping ;

Fujii, Toshiharu ;

Correia, Luis Claudio ;

Kawashiri, Masa-aki ;

Maria Garcia-Acuna, Jose ;

Southern, Danielle ;

Alfonso, Emilio ;

Terol, Belen ;

Garay, Alberto ;

Zhang, Dongfeng ;

Chen, Yalei ;

Xanthopoulou, Ioanna ;

Osman, Neriman ;

Moellmann, Helge ;

Shiomi, Hiroki ;

Giordana, Francesca ;

Scarano, Silvia ;

Gaita, Fiorenzo ;

Kowara, Michal ;

Filipiak, Krzysztof J. ;

Wang, Xiao ;

Yan, Yan ;

Fan, Jing-Yao ;

Ikari, Yuji ;

Nakahayshi, Takuya ;

Sakata, Kenji ;

Yamagishi, Masakazu ;

Kalpak, Oliver ;

Kedev, Sasko .

JOURNAL OF CARDIOVASCULAR MEDICINE, 2016, 17 (10) :744-749

[9] Contemporary antithrombotic strategies in patients with acute coronary syndrome admitted to cardiac care units in Italy: The EYESHOT Study [J].

De Luca, Leonardo ;

Leonardi, Sergio ;

Cavallini, Claudio ;

Lucci, Donata ;

Musumeci, Giuseppe ;

Caporale, Roberto ;

Abrignani, Maurizio G. ;

Lupi, Alessandro ;

Rakar, Serena ;

Gulizia, Michele M. ;

Bovenzi, Francesco M. ;

De Servi, Stefano ;

De Luca, L. ;

De Servi, S. ;

Caporale, R. ;

Cavallini, C. ;

Ceravolo, R. ;

Formigli, D. ;

Leonardi, S. ;

Lupi, A. ;

Musumeci, G. ;

Rakar, S. ;

Smecca, I. M. ;

Maggioni, A. P. ;

Lucci, D. ;

Lorimer, A. ;

Orsini, G. ;

Gonzini, L. ;

Fabbri, G. ;

Bianchini, E. ;

Abrignani, M. G. ;

Bonura, F. ;

Trimarco, B. ;

Galasso, G. ;

Misuraca, G. ;

Manes, M. T. ;

Tuccillo, B. ;

Irace, L. ;

Olivari, Z. ;

Totis, O. ;

Ledda, A. ;

Mauro, C. ;

Boccalatte, M. ;

Iliceto, S. ;

Cacciavillani, L. ;

Savonitto, S. ;

Tortorella, G. ;

Esposito, L. ;

De Rosa, P. ;

Calabro, P. .

EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE, 2015, 4 (05) :441-452

[10]

Gimbel M, 2020, LANCET, V395, P1374, DOI 10.1016/S0140-6736(20)30325-1

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