Impact of abciximab in elderly patients with high-risk acute coronary syndrome undergoing percutaneous coronary intervention: an observational registry study
Allan Z Iversen1, Soeren Galatius, Sune Pedersen
1Department of Cardiology P, Gentofte University Hospital, Hellerup, Denmark. allive01@geh.regionh.dk
Insights
Abciximab offers no benefit for elderly patients with high-risk acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This study found no significant difference in adverse outcomes for older patients treated with or without abciximab during PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Elderly patients (≥70 years) represent an increasing proportion of acute coronary syndrome (ACS) cases requiring percutaneous coronary intervention (PCI).
- The efficacy of glycoprotein IIb/IIIa inhibitor abciximab in high-risk elderly ACS patients undergoing PCI is uncertain, with conflicting prior reports.
- This study addresses the need for clarity on abciximab's role in this specific demographic.
Purpose of the Study:
- To evaluate the effectiveness of abciximab in elderly patients (≥70 years) with high-risk acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
- To determine if abciximab influences key adverse outcomes in this vulnerable patient population.
Main Methods:
- Analysis of a dedicated PCI registry including 2068 ACS patients with high-risk lesions.
- Prospective collection of baseline data and registration of endpoints within 1 year post-PCI.
- Stratification of patients by age (elderly vs. younger) and abciximab treatment status.
Main Results:
- Elderly patients comprised 42% of the cohort, presenting with more comorbidities and receiving abciximab less frequently.
- Abciximab showed no significant effect on combined endpoints, all-cause mortality, target vessel revascularization (TVR), or myocardial infarction (MI) in elderly patients.
- In contrast, abciximab significantly reduced all-cause mortality and the combined endpoint risk in younger ACS patients.
Conclusions:
- Abciximab treatment demonstrated no clinical benefit for elderly high-risk ACS patients undergoing PCI in this observational study.
- These findings suggest that current treatment strategies for elderly ACS patients undergoing PCI may need re-evaluation regarding abciximab use.
- Further research may be warranted to explore alternative or optimized therapeutic approaches for older individuals with ACS.
Background:
An increasing proportion of patients with acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI) are classified as elderly (aged ≥70 years). The glycoprotein IIb/IIIa inhibitor abciximab is known to reduce adverse outcomes in patients aged <70 years with high-risk ACS undergoing PCI, but conflicting findings relating to its effects in the elderly have been reported.
Objective:
The aim of this study was to evaluate the effect of abciximab in elderly high-risk ACS patients undergoing PCI.
Methods:
From our dedicated PCI registry we identified 2068 ACS patients with high-risk lesions that were treated with PCI. Baseline data were collected prospectively. All-cause mortality, target vessel revascularization (TVR), myocardial infarction (MI), and the combination of these were primary study endpoints. All endpoints within 1 year after PCI were registered and validated. The population was subsequently stratified according to age and use of abciximab.
Results:
Elderly patients constituted 42% of the total population. They presented with more co-morbidities, were less frequently treated with abciximab and had a higher risk of reaching the combined endpoint and higher all-cause mortality than younger patients. The age/abciximab stratified analysis revealed no effect of abciximab on any of the endpoints in elderly patients (combined endpoint: no abciximab 22.6% vs abciximab 23.4%, p=0.85; all-cause mortality: no abciximab 15.4% vs abciximab 15.9%, p=0.91; TVR: no abciximab 3.4% vs abciximab 5.5%, p=0.21; MI: no abciximab 7.0% vs abciximab 8.5%, p=0.54), whereas all-cause mortality and the risk of reaching the combined endpoint were significantly reduced in younger patients (combined endpoint: no abciximab 14.0% vs abciximab 9.4%, p=0.03; all-cause mortality: no abciximab 4.5% vs abciximab 1.7%, p=0.02; TVR: no abciximab 5.5% vs abciximab 4.3%, p=0.39; MI: no abciximab 7.2% vs abciximab 6.6%, p=0.80). These findings were confirmed in our adjusted analyses.
Conclusions:
In this large observational study we found no benefit of abciximab treatment in elderly high-risk ACS patients who underwent PCI. These findings should be taken into consideration when deciding on the treatment strategy for elderly ACS patients undergoing PCI.
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