In‐Hospital Outcomes of Dual Loading Antiplatelet Therapy in Patients 75 Years and Older With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Findings From the CCC‐ACS (Improving Care for Cardiovascular Disease in China‐Acute Coronary Syndrome) Project

Abstract

BackgroundElderly patients with acute coronary syndrome (ACS) are at high risk for ischemic and bleeding events. This study aimed to evaluate the clinical effectiveness and safety of dual loading antiplatelet therapy for patients 75 years and older undergoing percutaneous coronary intervention for ACS.Methods and ResultsThe Improving Care for Cardiovascular Disease in China‐ACS project was a collaborative study of the American Heart Association and Chinese Society of Cardiology. A total of 5887 patients 75 years and older with ACS who had percutaneous coronary intervention and received dual antiplatelet therapy with aspirin and P2Y12 inhibitors (clopidogrel or ticagrelor) between November 2014 and June 2017 were enrolled. The primary effectiveness and safety outcomes were in‐hospital major adverse cardiovascular events and major bleeding. Hazard ratios (HRs) of in‐hospital outcomes with different loading statuses of antiplatelet therapy were estimated using Cox proportional hazard models with multivariate adjustment. A propensity score–matched analysis was also conducted. Compared with patients receiving a dual nonloading dose, patients taking a dual loading dose had increased risks of both major adverse cardiovascular events (HR, 1.66, 95% confidence interval, 1.13–2.44; [P=0.010]) and major bleeding (HR, 2.34, 95% confidence interval, 1.75–3.13; [P<0.001]). Among 3284 propensity score–matched patients, a dual loading dose was associated with a 1.36‐fold risk of major adverse cardiovascular events (HR, 1.36; 95% confidence interval, 0.88–2.11 [P=0.168]) and a 2.08‐fold risk of major bleeding (HR, 2.08; 95% confidence interval, 1.47–2.93 [P<0.001]).ConclusionsA dual loading dose of antiplatelet therapy was associated with increased major bleeding risk but not with decreased major adverse cardiovascular events risk among patients 75 years and older undergoing percutaneous coronary intervention for ACS in China.Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT02306616.

A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks

“…The CREATIVE study explored antiplatelet treatment options for patients after PCI in China, and studies have shown that for patients with low response to antiplatelet drugs after PCI, a triple antiplatelet intensive therapy combined with cilostazol is safe and effective ( Tang et al, 2018 ). Bleeding events should be paid special attention when administrating dual antiplatelet treatment to ACS patients aged 75 and older receiving PCI ( Zhao et al, 2018a ). The risk of all-cause, cardiovascular, and stroke deaths in patients with AF is significantly higher than in patients with sinus rhythm ( Li et al, 2015 ).…”

Effect of different revascularization times on intermediate-risk non-ST-elevation acute coronary syndrome

“…Therefore, on the basis of previous studies 16 – 18 , according to TIMI risk score, we mainly selected the most representative intermediate-risk NSTE-ACS patients for our study. The prognostic value of both the GRACE risk score and the TIMI risk index has been demonstrated in patients with NSTEMI.…”

Combined glycoprotein IIb/IIIa inhibitor therapy with ticagrelor for patients with acute coronary syndrome

“…Stroke was divided into ischemic stroke and intracranial bleeding, which was defined as a neurological deficit caused by an acute focal injury of the central nervous system of vascular cause. The definition of bleeding events have already described in a previous study [ 16 ].…”