Age-dependent effect of abciximab in patients with acute coronary syndromes treated with percutaneous coronary
Gjin Ndrepepa1, Adnan Kastrati, Julinda Mehilli
1Deutsches Herzzentrum, Technische Universität, Lazarettstrasse 36, 80636 München, Germany.
Insights
Abciximab provides greater benefit for younger patients with non-ST-elevation acute coronary syndromes undergoing percutaneous coronary intervention (PCI). Older patients showed no significant difference in major adverse cardiac events (MACE) with abciximab use.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Limited age-based efficacy data for abciximab in non-ST-elevation acute coronary syndromes (NSTE-ACS) undergoing PCI.
- Need to assess age-dependent clinical benefits of abciximab in PCI-treated ACS patients.
Purpose of the Study:
- To determine if abciximab's efficacy in NSTE-ACS patients undergoing PCI varies by age.
- To analyze age-dependent differences in major adverse cardiac events (MACE) following PCI with abciximab.
Main Methods:
- Retrospective analysis of 2022 NSTE-ACS patients from the ISAR-REACT 2 study randomized to abciximab or placebo.
- Patients stratified into younger (<70 years) and older (≥70 years) groups based on logistic regression and bootstrap resampling.
- Primary endpoint: 30-day incidence of MACE post-PCI.
Main Results:
- Younger patients (<70 years) receiving abciximab had significantly lower MACE (7.7%) compared to placebo (13.3%; RR 0.57, P=0.001).
- Older patients (≥70 years) showed no significant difference in MACE between abciximab (10.9%) and placebo (9.9%; RR 1.10, P=0.65).
- Significant interaction between age and abciximab efficacy for MACE reduction (P=0.04), with greater benefit in younger individuals.
Conclusions:
- Abciximab efficacy in NSTE-ACS patients undergoing PCI is age-dependent.
- Younger patients (<70 years) experience greater clinical benefit from abciximab compared to older patients.
Background:
No studies have specifically performed an age-based analysis of the efficacy of abciximab in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention (PCI). The aim of the study was to assess whether there are age-dependent differences in the clinical benefit of abciximab in patients with acute coronary syndrome treated with PCI.
Methods And Results:
We performed this retrospective analysis of 2022 patients with acute coronary syndrome enrolled in the Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT 2) study and randomized to receive abciximab or placebo during a PCI procedure. The incidence of major adverse cardiac events (MACE) during the 30 days after PCI was the primary end point of the study. On the basis of the cutoff age value provided by logistic regression in connection with bootstrap resampling, patients were divided into those younger (n=1220) and older (n=802) than 70 years. Among younger patients, the incidence of MACE was 7.7% in the abciximab group versus 13.3% in the placebo group (relative risk 0.57, 95% confidence interval 0.40 to 0.80, P=0.001). In contrast, no difference was observed among older patients: The incidence of MACE was 10.9% in the abciximab group versus 9.9% in the placebo group (relative risk 1.10, 95% confidence interval 0.72 to 1.69, P=0.65). After adjustment for other variables, including cardiac troponin, there was a significant interaction between age and abciximab (P=0.04) with respect to MACE reduction, with abciximab being more effective in younger patients.
Conclusions:
In patients with non-ST-elevation acute coronary syndromes undergoing PCI, the efficacy of abciximab appears to be age-dependent, with greater benefit among younger patients.
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