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- Title
Prospective application of a bleeding and ischemic risks-adjusted antithrombotic protocol in elderly patients revascularized with everolimus-eluting stents: EPIC05-Sierra75 study.
- Authors
de la Torre Hernandez, Jose M.; Lopez Palop, Ramon; Jimenez Mazuecos, Jesus M.; Carrillo Sáez, Pilar; Gutierez-Barrios, Alejandro; Pinar, Eduardo; Cid, Belen; Fernandez, Luis; Garcia Camarero, Tamara; Urbano-Carrillo, Cristóbal; Oteo Dominguez, Juan F.; Jimenez Diaz, Victor A.; Gomez Menchero, Antonio E.; Galindo Fernández, Eladio; Córdoba Soriano, Juan G.; Ocaranza, Raymundo; Arroyo Úcar, Eduardo; San Roman, Koldobika Garcia; Leal, Silvio; Martínez Cáceres, Ginés
- Abstract
OBJECTIVES Elderly patients show a higher incidence of ischemic and bleeding events after percutaneous transluminal coronary intervention (PCI). We sought to investigate outcomes in elderly patients treated with antithrombotic strategy guided by bleeding and ischemic risks after revascularization with last generation everolimus-eluting stent (EES). METHODS Prospective multicenter registry including patients over 75 years revascularized with EES and antithrombotic therapy guided by clinical presentation, PCI complexity and PRECISE DAPT score. Co-primary safety endpoints were: (1) composite of cardiac death, myocardial infarction and stent thrombosis and; (2) bleeding (BARC 2-5). Primary efficacy endpoint was target lesion revascularization. A matched group of patients revascularized with current drug-eluting stents and no such tailored antithrombotic therapy was used as control. RESULTS Finally, 1064 patients were included in SIERRA-75 cohort, 80.8 ± 4.2 years, 36.6% women, 71% acute coronary syndromes (ACS) and 53.6% complex PCI. Co-primary safety endpoint of major adverse cardiovascular events was met in 6.2%, coprimary safety endpoint of bleeding in 7.8% and primary efficacy endpoint of TKLR in 1.5%. The multivariable adjusted model showed no significant association of the prescribed short/long dual antiplatelet therapy (DAPT) durations with any endpoint suggesting a well tailored therapy. No stent thrombosis reported in the subgroup with 1-3 months DAPT duration. As compared to control group, bleeding BARC 2-5 was significantly lower in SIERRA-75 group (7.4% vs. 10.2%, P = 0.04) as well as the net safety-efficacy endpoint (14.3% vs. 18.5%, P = 0.02). CONCLUSIONS In elderly population, the application of this risks-adjusted antithrombotic protocol after revascularization with last generation EES seems to be associated with an improved prognosis in terms of ischemic and bleeding outcomes.
- Subjects
SPAIN; PORTUGAL; HEMORRHAGE risk factors; THERAPEUTIC use of fibrinolytic agents; ISCHEMIA; RESEARCH; CARDIOVASCULAR diseases risk factors; SAFETY; PERCUTANEOUS coronary intervention; REVASCULARIZATION (Surgery); DRUG-eluting stents; LOG-rank test; DISEASE incidence; MYOCARDIAL infarction; CASE-control method; RETROSPECTIVE studies; FISHER exact test; MEDICAL protocols; RISK assessment; EVEROLIMUS; CARDIAC arrest; DESCRIPTIVE statistics; CHI-squared test; KAPLAN-Meier estimator; DATA analysis software; HEMORRHAGE; LONGITUDINAL method; PROPORTIONAL hazards models; DISEASE risk factors; OLD age
- Publication
Journal of Geriatric Cardiology, 2022, Vol 19, Issue 5, p354
- ISSN
1671-5411
- Publication type
Article
- DOI
10.11909/j.issn.1671-5411.2022.05.009