TY - JOUR
T1 - Net clinical benefit of different strategies of dual antiplatelet therapy in elderly patients
T2 - Data from the praise registry
AU - on behalf of the PRAISE study group
AU - D'Ascenzo, Fabrizio
AU - Elia, Edoardo
AU - de Filippo, Ovidio
AU - Manai, Rossella
AU - Breviario, Susanna
AU - Bruno, Francesco
AU - Iannaccone, Mario
AU - Wańha, Wojciech
AU - Bianco, Matteo
AU - Patti, Giuseppe
AU - Raposeiras-Roubin, Sergio
AU - Abu-Assi, Emad
AU - Bo, Mario
AU - De Ferrari, Gaetano Maria
AU - Conrotto, Federico
N1 - Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/4/15
Y1 - 2022/4/15
N2 - Background: The safety and efficacy of potent P2Y12 inhibitors (Ticagrelor and Prasugrel) in dual antiplatelet therapy (DAPT) with aspirin in elderly acute coronary syndrome (ACS) patients remains unclear. Methods: All ACS patients aged 75 years and older treated with Percutaneous Coronary Intervention (PCI) from PRAISE dataset were included. The safety and efficacy of Ticagrelor vs Clopidogrel was evaluated with inverse probability of treatment weighting (IPTW). Sensitivity analysis was performed for patients older or equal than 85 years old. All-cause mortality was the primary endpoint, while myocardial infarction (MI), Bleeding Academic Research Consortium (BARC) 3–5 bleedings and Major and Net Adverse Clinical and Cardiac Events (MACE and NACE) were the secondary ones. Results: 4287 patients were included, 3197 treated with Clopidogrel and 1090 with Ticagrelor. After 16 ± 3 months, Ticagrelor showed neutral effect on NACE and mortality (HR 0.98; 0.63–1.52, p = 0.94 and HR 0.38; 0.14–1.04, p = 0,06), reduced risk of MACE and MI (HR 0.82; 0.23–0.91, p = 0.03 and HR 0.43; 0.14–0.89, p = 0.04) and increased risk of BARC 3–5 bleeding (HR 2.14; 1.19–3.85, p = 0.001). In very elderly patients (≥85 years) Ticagrelor decreased risk of MI and increased risk of bleeding (HR 0.69; 0.22–0.95, p = 0.04 and HR 2.36; 1.02–5.52, p = 0.04, all 95%CI) with neutral effect on NACE and MACE. Conclusions: In elderly ACS patients treated with PCI, Ticagrelor was associated with neutral effect on all-cause mortality, lower risk MACE and MI compared with Clopidogrel. Such benefit was counterbalanced by increased risk of major bleedings. These results were consistent among patients aged 85 years and older.
AB - Background: The safety and efficacy of potent P2Y12 inhibitors (Ticagrelor and Prasugrel) in dual antiplatelet therapy (DAPT) with aspirin in elderly acute coronary syndrome (ACS) patients remains unclear. Methods: All ACS patients aged 75 years and older treated with Percutaneous Coronary Intervention (PCI) from PRAISE dataset were included. The safety and efficacy of Ticagrelor vs Clopidogrel was evaluated with inverse probability of treatment weighting (IPTW). Sensitivity analysis was performed for patients older or equal than 85 years old. All-cause mortality was the primary endpoint, while myocardial infarction (MI), Bleeding Academic Research Consortium (BARC) 3–5 bleedings and Major and Net Adverse Clinical and Cardiac Events (MACE and NACE) were the secondary ones. Results: 4287 patients were included, 3197 treated with Clopidogrel and 1090 with Ticagrelor. After 16 ± 3 months, Ticagrelor showed neutral effect on NACE and mortality (HR 0.98; 0.63–1.52, p = 0.94 and HR 0.38; 0.14–1.04, p = 0,06), reduced risk of MACE and MI (HR 0.82; 0.23–0.91, p = 0.03 and HR 0.43; 0.14–0.89, p = 0.04) and increased risk of BARC 3–5 bleeding (HR 2.14; 1.19–3.85, p = 0.001). In very elderly patients (≥85 years) Ticagrelor decreased risk of MI and increased risk of bleeding (HR 0.69; 0.22–0.95, p = 0.04 and HR 2.36; 1.02–5.52, p = 0.04, all 95%CI) with neutral effect on NACE and MACE. Conclusions: In elderly ACS patients treated with PCI, Ticagrelor was associated with neutral effect on all-cause mortality, lower risk MACE and MI compared with Clopidogrel. Such benefit was counterbalanced by increased risk of major bleedings. These results were consistent among patients aged 85 years and older.
KW - Acute coronary syndrome
KW - Clopidogrel
KW - Dual antiplatelet therapy
KW - Elderly
KW - Prasugrel
KW - Ticagrelor
UR - http://www.scopus.com/inward/record.url?scp=85123713907&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2022.01.019
DO - 10.1016/j.ijcard.2022.01.019
M3 - Article
SN - 0167-5273
VL - 353
SP - 9
EP - 14
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -