Fabrizio D'Ascenzo1, Enrico Cerrato2,3, Matteo Bianco4, Alessandro Careggio4, Carlo Alberto Biolè4, Giorgio Quadri5,6, Alicia Quiros7, Sergio Raposeiras-Roubin8, Emad Abu-Assi8, Tim Kinnaird9, Albert Ariza-Solè10, Christoph Liebetrau11, Sergio Manzano-Fernàndez12, Giacomo Boccuzzi13, Jose P S Henriques14, Amanda Spirito4, Christian Templin15, Stephen B Wilton16, Lazar Velicki17,18, Luis Correia19, Andrea Rognoni20, Fabrizio Ugo21, Ivàn Nunez-Gil22, Toshiharu Fujii23, Alessandro Durante24, Xiantao Song25, Tetsuma Kawaji26, Dimitrios Alexopoulos27, Zenon Huczek28, Josè Ramòn Gonzàlez Juanatey29, Shao-Ping Nie30, Masa-Aki Kawashiri31, Umberto Morbiducci32, Alberto Dominguez-Rodriguez33, Paola Destefanis4, Alessia Luciano4, Gaetano Maria De Ferrari1, Ferdinando Varbella5,6, Laura Montagna4. 1. Cardiology Division, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy. 2. Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy. enrico.cerrato@gmail.com. 3. Rivoli Infermi Hospital, Rivoli, Turin, Italy. enrico.cerrato@gmail.com. 4. Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy. 5. Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy. 6. Rivoli Infermi Hospital, Rivoli, Turin, Italy. 7. Department of Statistics, University of Leon, Leon, Spain. 8. Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Pontevedra, Spain. 9. Cardiology Department, University Hospital of Wales, Cardiff, UK. 10. Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain. 11. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 12. Department of Cardiology, University Hospital Virgen Arrtixaca, Murcia, Spain. 13. Department of Cardiology, S.G. Bosco Hospital, Torino, Italy. 14. Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. 15. Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland. 16. Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada. 17. Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia. 18. Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia. 19. Department of Cardiology, Medical and Public Health School of Bahia, Salvador, Brazil. 20. Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy. 21. Cardiology Division, Presidio Ospedaliero Sant'Andrea di Vercelli, Vercelli, Italy. 22. Interventional Cardiology, Cardiovascular Institute, Hospital Clinico Universitario San Carlos, Madrid, Spain. 23. Division of Cardiovascular Medicine, Department of Cardiology, Tokai University School of Medicine, Shimokasuya, Isehara, Japan. 24. U.O. Cardiologia, Ospedale Valduce, Como, Italy. 25. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China. 26. Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan. 27. Department of Cardiology, Patras University Hospital, Patras, Greece. 28. Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. 29. Servicio de Hemodinàmica, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruna, Spain. 30. Institute of Heart, Lung and Blood Vessel Disease, Beijing, China. 31. Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan. 32. Department of Mechanical and Aerospace Engineering, PolitoBIOMed Lab, Politecnico di Torino, Torino, Italy. 33. Department of Cardiology, Hospital Universitario de Canarias, La Cuesta, Santa Cruz de Tenerife, Spain.
Abstract
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.
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.
Authors: Clara Bonanad; Francisca Esteve-Claramunt; Sergio García-Blas; Ana Ayesta; Pablo Díez-Villanueva; Jose-Ángel Pérez-Rivera; José Luis Ferreiro; Joaquim Cánoves; Francisco López-Fornás; Albert Ariza Solé; Sergio Raposerias; David Vivas; Regina Blanco; Daznia Bompart Berroterán; Alberto Cordero; Julio Núñez; Lorenzo Fácila; Iván J Núñez-Gil; José Luis Górriz; Vicente Bodí; Manuel Martínez-Selles; Juan Miguel Ruiz Nodar; Francisco Javier Chorro Journal: J Clin Med Date: 2022-05-26 Impact factor: 4.964