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Ticagrelor or Clopidogrel After an Acute Coronary Syndrome in the Elderly: A Propensity Score Matching Analysis from
Matteo Bianco1, Alessandro Careggio1, Carlo Alberto Biolè1
1Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
Insights
Ticagrelor did not significantly increase major bleeding in elderly acute coronary syndrome patients undergoing percutaneous coronary intervention. However, ticagrelor improved survival rates, suggesting a favorable risk-benefit profile in this population.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Elderly patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) present unique challenges regarding antiplatelet therapy.
- Previous studies suggested a potentially higher risk of bleeding with ticagrelor compared to clopidogrel in this demographic.
- Real-world data is crucial to evaluate the safety and efficacy of ticagrelor in elderly ACS patients post-PCI.
Purpose of the Study:
- To assess the incidence of major bleeding (MB), reinfarction (re-MI), and all-cause death in elderly patients with ACS treated with PCI.
- To compare the safety and efficacy of ticagrelor versus clopidogrel in patients aged 75 years and older.
- To determine if ticagrelor increases the risk of major bleeding in elderly patients compared to clopidogrel.
Main Methods:
- A merged analysis of two large real-world registries (RENAMI and BleeMACS) was conducted.
- Patients were stratified into two groups: <75 years and ≥75 years old.
- Propensity score matching (PSM) was used to create comparable treatment groups for analysis of BARC 3-5 MB, re-MI, and all-cause death at 1-year follow-up.
Main Results:
- Ticagrelor significantly reduced reinfarction (HR 0.31) and all-cause death (HR 0.60) irrespective of age.
- In patients ≥75 years, ticagrelor showed a trend towards reduced reinfarction (HR 0.25) and significantly reduced all-cause death (HR 0.32).
- Ticagrelor did not significantly increase major bleeding events (HR 1.49) in elderly patients, with age identified as an independent risk factor for bleeding.
Conclusions:
- Ticagrelor demonstrated a favorable safety and efficacy profile in elderly ACS patients post-PCI, not significantly increasing major bleeding compared to clopidogrel.
- Ticagrelor significantly improved 1-year survival in this elderly population.
- Further research focusing on elderly patients is warranted to confirm these findings and optimize antiplatelet strategies.
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.
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