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Prospective application of a bleeding and ischemic risks-adjusted antithrombotic protocol in elderly patients

Jose M de la Torre Hernandez1, Ramon Lopez Palop2, Jesus M Jimenez Mazuecos3

  • 1Cardiology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.

Journal of Geriatric Cardiology : JGC
|June 20, 2022
PubMed

Insights

Elderly patients undergoing percutaneous coronary intervention (PCI) benefit from a tailored antithrombotic strategy. This approach, using everolimus-eluting stents (EES) and risk assessment, improved both bleeding and ischemic outcomes in older adults.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Elderly patients face increased risks of ischemic and bleeding events post-percutaneous coronary intervention (PCI).
  • Optimizing antithrombotic therapy is crucial for improving outcomes in this vulnerable population.
  • Last-generation everolimus-eluting stents (EES) offer advancements in coronary revascularization.

Purpose of the Study:

  • To evaluate the efficacy and safety of a risk-adjusted antithrombotic strategy in elderly patients (over 75 years) undergoing PCI with EES.
  • To compare outcomes with a tailored antithrombotic regimen versus standard therapy in a matched control group.
  • To assess the impact of bleeding and ischemic risk stratification on clinical endpoints.

Main Methods:

  • A prospective multicenter registry (SIERRA-75) included 1064 elderly patients (≥75 years) treated with EES.
  • Antithrombotic therapy was guided by clinical presentation, PCI complexity, and the PRECISE DAPT score.
  • Co-primary safety endpoints included major adverse cardiovascular events and Bleeding Academic Research Consortium (BARC) 2-5 bleeding; target lesion revascularization (TLR) was the primary efficacy endpoint. A matched control group received standard care.

Main Results:

  • The SIERRA-75 cohort (mean age 80.8 years) demonstrated favorable outcomes: 6.2% for major adverse cardiovascular events, 7.8% for BARC 2-5 bleeding, and 1.5% for TLR.
  • No stent thrombosis was reported in patients with 1-3 months of dual antiplatelet therapy (DAPT).
  • The SIERRA-75 group showed significantly lower BARC 2-5 bleeding (7.4% vs. 10.2%, P=0.04) and a better net safety-efficacy endpoint (14.3% vs. 18.5%, P=0.02) compared to the control group.

Conclusions:

  • A risk-adjusted antithrombotic protocol following EES revascularization in elderly patients is associated with improved ischemic and bleeding outcomes.
  • Tailored antithrombotic therapy effectively balances safety and efficacy in older individuals undergoing complex PCI.
  • This strategy represents a promising approach to enhance prognosis in elderly patients treated with modern drug-eluting stents.
Abstract

Keywords:
=AcademicBARCBleedingConsortiumResearch

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