Bleeding in the Elderly: Risk Factors and Impact on Clinical Outcomes After an Acute Coronary Syndrome, a Sub-study
Benoit Lattuca1,2, Guillaume Cayla2, Johanne Silvain1
1ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Sorbonne University, 47-83 bld de l'Hôpital, 75013, Paris, France.
Insights
Elderly patients undergoing stenting for acute coronary syndrome (ACS) have a high risk of bleeding. Comorbidities and advanced age, not antiplatelet therapy, predict bleeding events and increase stroke risk.
Area of Science:
- Cardiology
- Geriatrics
- Clinical Trials
Background:
- Elderly patients are a high-risk group for bleeding complications.
- This demographic is often under-represented in clinical trials.
- Understanding bleeding risks in older adults post-percutaneous coronary intervention is crucial.
Purpose of the Study:
- To determine the incidence of bleeding in elderly patients after ACS treated with PCI.
- To identify predictive factors for bleeding in this population.
- To assess the impact of bleeding on subsequent ischemic outcomes.
Main Methods:
- Analysis of 877 patients aged ≥75 years from the ANTARCTIC randomized trial.
- Data collection on Bleeding Academic Research Consortium (BARC) bleeding complications and major adverse cardiovascular events (MACE) over 1 year.
- Statistical analysis including adjusted hazard ratios (adj.HR) and confidence intervals (CI).
Main Results:
- Clinically relevant bleeding (BARC types 2, 3, or 5) occurred in 20.6% of patients within 1 year.
- Anemia, severe chronic renal failure, and femoral access were independent predictors of bleeding.
- Age >85 years predicted major bleeding events (BARC types 3 or 5).
- Bleeding events were associated with a higher rate of MACE, particularly stroke.
Conclusions:
- Approximately one in five elderly patients undergoing stenting for ACS experienced clinically relevant bleeding.
- Bleeding events were strongly linked to an increased risk of subsequent stroke.
- Comorbidities and advanced age (>85 years) were key predictors of bleeding, outweighing antiplatelet therapy's influence.
Background:
Elderly patients are at high-risk of bleeding, but are under-represented in clinical trials.
Objectives:
The aims were to determine the incidence and the predictive factors of bleeding and to assess the impact of bleeding on further ischemic outcomes in elderly patients after acute coronary syndrome (ACS) treated with percutaneous coronary intervention.
Methods:
From the 877 patients aged ≥ 75 years included in the ANTARCTIC randomized trial, data on Bleeding Academic Research Consortium (BARC) bleeding complications and major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, myocardial infarction, and stroke, were collected over 1 year.
Results:
Clinically relevant bleeding events (BARC types 2, 3, or 5) were observed in 20.6% of patients (n = 181) at 1 year, of which, one third occurred in the first month. Anemia (adjusted hazard ratio [adj.HR] 3.98, 95% confidence interval [CI] 1.41-11.22; p = 0.009), severe chronic renal failure (adj.HR 1.83, 95% CI 1.12-2.98; p = 0.015), and femoral access (adj.HR 2.54, 95% CI 1.71-3.77; p < 0.001) were independently associated with clinically relevant bleeding events, while age > 85 years (adj.HR 2.22, 95% CI 1.14-4.30; p = 0.018) was independently associated with major bleeding events (BARC types 3 or 5). Patients with a clinically relevant bleeding event had a higher rate of MACE at 1 year (adj.HR 2.04, 95% CI 1.24-3.38; p = 0.005), with a particularly strong effect on stroke (adj.HR 5.55, 95% CI 2.04-15.06; p < 0.001).
Conclusions:
Clinically relevant bleeding events were observed in one out of five elderly patients undergoing stenting for an ACS and were strongly associated with further stroke occurrence. Rather than the antiplatelet therapy, comorbidities and an age > 85 years predicted bleeding outcomes in this elderly population.
Clinical Trial Registration:
Clinicaltrials.gov identifier: NCT01538446. https://www.clinicaltrials.gov .
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