Impact of body mass index on clinical outcome among elderly patients with acute coronary syndrome treated with percutaneous coronary intervention: Insights from the ELDERLY ACS 2 trial.

Acute Coronary Syndrome / diagnostic imaging Age Factors Aged Aged, 80 and over Body Mass Index Cause of Death Clopidogrel / administration & dosage Comorbidity Female Frail Elderly Geriatric Assessment Hemorrhage / chemically induced Humans Italy Male Non-ST Elevated Myocardial Infarction / diagnostic imaging Percutaneous Coronary Intervention / adverse effects Platelet Aggregation Inhibitors / administration & dosage Prasugrel Hydrochloride / administration & dosage Recurrence Risk Assessment Risk Factors ST Elevation Myocardial Infarction / diagnostic imaging Time Factors Treatment Outcome

Acute coronary syndrome Body mass index Elderly patients

Journal

Nutrition, metabolism, and cardiovascular diseases : NMCD

ISSN: 1590-3729

Titre abrégé: Nutr Metab Cardiovasc Dis

Pays: Netherlands

ID NLM: 9111474

Informations de publication

Date de publication:
07 05 2020

Historique:

received: 07 08 2019

revised: 26 12 2019

accepted: 12 01 2020

pubmed: 5 3 2020

medline: 21 7 2020

entrez: 5 3 2020

Statut: ppublish

Résumé

Elderly patients are at increased risk of hemorrhagic and thrombotic complications after an acute coronary syndrome (ACS). Frailty, comorbidities and low body weight have emerged as conditioning the prognostic impact of dual antiplatelet therapy (DAPT). The aim of the present study was to investigate the prognostic impact of body mass index (BMI) on clinical outcome among patients included in the Elderly-ACS 2 trial, a randomized, open-label, blinded endpoint study comparing low-dose (5 mg) prasugrel vs clopidogrel among elderly patients with ACS. Our population is represented by 1408 patients enrolled in the Elderly-ACS 2 trial. BMI was calculated at admission. The primary endpoint of this analysis was cardiovascular (CV) mortality. Secondary endpoints were all-cause death, recurrent MI, Bleeding Academic Research Consortium (BARC) type 2 or 3 bleeding, and re-hospitalization for cardiovascular reasons or stent thrombosis within 12 months after index admission. Patients were grouped according to median values of BMI (<or ≥ 25.7 kg/m2). BMI was associated with hypertension, diabetes, hypercholesterolemia, estimated glomerular filtration rate and hemoglobin (p < 0.001), and inversely with age (p = 0.005). Overweight patients displayed larger use of diuretics at admission (p = 0.03), aspirin pre-randomization (p = 0.01) and radial access (p = 0.04). At a median follow-up of 367 [337-378] days, BMI did not affect CV mortality in the overall population 4% vs 3.8%; adjusted HR [95%CI] = 2.3 [0.8-6.5], p = 0.12. Similar findings were observed for our secondary efficacy and safety endpoints. Results did not change when considering separately higher risk subsets of patients, (female gender, diabetics, ST-segment elevation myocardial infarction or the type of DAPT treatment allocation), with no significant interaction between these population characteristics and BMI. Among elderly patients with ACS, BMI did not condition the survival or the risk of major cardiovascular and bleeding complications. The results were consistent across several patient risk categories.

Sections du résumé

BACKGROUND AND AIM

METHODS AND RESULTS

Our population is represented by 1408 patients enrolled in the Elderly-ACS 2 trial. BMI was calculated at admission. The primary endpoint of this analysis was cardiovascular (CV) mortality. Secondary endpoints were all-cause death, recurrent MI, Bleeding Academic Research Consortium (BARC) type 2 or 3 bleeding, and re-hospitalization for cardiovascular reasons or stent thrombosis within 12 months after index admission. Patients were grouped according to median values of BMI (<or ≥ 25.7 kg/m2). BMI was associated with hypertension, diabetes, hypercholesterolemia, estimated glomerular filtration rate and hemoglobin (p < 0.001), and inversely with age (p = 0.005). Overweight patients displayed larger use of diuretics at admission (p = 0.03), aspirin pre-randomization (p = 0.01) and radial access (p = 0.04). At a median follow-up of 367 [337-378] days, BMI did not affect CV mortality in the overall population 4% vs 3.8%; adjusted HR [95%CI] = 2.3 [0.8-6.5], p = 0.12. Similar findings were observed for our secondary efficacy and safety endpoints. Results did not change when considering separately higher risk subsets of patients, (female gender, diabetics, ST-segment elevation myocardial infarction or the type of DAPT treatment allocation), with no significant interaction between these population characteristics and BMI.

CONCLUSIONS

Among elderly patients with ACS, BMI did not condition the survival or the risk of major cardiovascular and bleeding complications. The results were consistent across several patient risk categories.

Identifiants

DOI: 10.1016/j.numecd.2020.01.001 PMID: 32127336

pubmed: 32127336

pii: S0939-4753(20)30017-X

doi: 10.1016/j.numecd.2020.01.001

pii:

doi:

Substances chimiques

Platelet Aggregation Inhibitors 0

Clopidogrel A74586SNO7

Prasugrel Hydrochloride G89JQ59I13

Types de publication

Comparative Study Journal Article Multicenter Study Randomized Controlled Trial

Langues

eng

Sous-ensembles de citation

Pagination

730-737

Informations de copyright

Copyright © 2020 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest None.