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

BACKGROUND:

Elderly 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 RESULTS:

The 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]).

CONCLUSIONS:

A 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.

• Authors: Guanqi Zhao, Mengge Zhou, Changsheng Ma, Yong Huo, Sidney C Smith Jr, Gregg C Fonarow, Junbo Ge, Yaling Han, Jing Liu, Yongchen Hao, Jun Liu, Xiao Wang, Kathryn A Taubert, Louise Morgan, Dong Zhao, Shaoping Nie, CCC‐ACS Investigators
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 7 Issue 7 (03 30 2018) ISSN: 2047-9980 [Electronic] England
• PMID: 29602767 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Chemical References

• Platelet Aggregation Inhibitors
• Purinergic P2Y Receptor Antagonists
• Clopidogrel
• Ticagrelor
• Aspirin

Topics

• Acute Coronary Syndrome (blood, diagnosis, mortality, therapy)
• Age Factors
• Aged
• Aged, 80 and over
• Aspirin (administration & dosage, adverse effects)
• China (epidemiology)
• Clopidogrel (administration & dosage, adverse effects)
• Databases, Factual
• Drug Therapy, Combination
• Female
• Hemorrhage (chemically induced, epidemiology, mortality)
• Humans
• Male
• Percutaneous Coronary Intervention (adverse effects, mortality)
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Purinergic P2Y Receptor Antagonists (administration & dosage, adverse effects)
• Quality Improvement
• Registries
• Risk Assessment
• Risk Factors
• Ticagrelor (administration & dosage, adverse effects)
• Time Factors
• Treatment Outcome