Treatment of elderly patients with non-ST-elevation myocardial infarction: the nationwide POPular age registry.
Antiplatelet therapy
Elderly
Non-ST-elevation myocardial infarction
Therapy
Journal
Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
ISSN: 1568-5888
Titre abrégé: Neth Heart J
Pays: Netherlands
ID NLM: 101095458
Informations de publication
Date de publication:
28 Sep 2023
28 Sep 2023
Historique:
accepted:
02
08
2023
medline:
28
9
2023
pubmed:
28
9
2023
entrez:
28
9
2023
Statut:
aheadofprint
Résumé
We describe the current treatment of elderly patients with non-ST-elevation myocardial infarction (NSTEMI) enrolled in a national registry. The POPular AGE registry is a prospective, multicentre study of patients ≥ 75 years of age presenting with NSTEMI, performed in the Netherlands. Management was at the discretion of the treating physician. Cardiovascular events consisted of cardiovascular death, myocardial infarction and ischaemic stroke. Bleeding was classified according to the Bleeding Academic Research Consortium (BARC) criteria. A total of 646 patients were enrolled between August 2016 and May 2018. Median age was 81 (IQR 77-84) years and 58% were male. Overall, 75% underwent coronary angiography, 40% percutaneous coronary intervention, and 11% coronary artery bypass grafting, while 49.8% received pharmacological therapy only. At discharge, dual antiplatelet therapy (aspirin and P2Y In this national registry of elderly patients with NSTEMI, the majority are treated according to current European Society of Cardiology guidelines. Both the cardiovascular and bleeding risk are highest during the 1st month after NSTEMI. However, the cardiovascular risk was three times as high as the bleeding risk.
Identifiants
pubmed: 37768542
doi: 10.1007/s12471-023-01812-0
pii: 10.1007/s12471-023-01812-0
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
© 2023. The Author(s).
Références
Collet J‑P, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42:1289–367.
doi: 10.1093/eurheartj/ehaa575
pubmed: 32860058
Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J. 2018;39:213–60.
doi: 10.1093/eurheartj/ehx419
pubmed: 28886622
Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357:2001–15.
doi: 10.1056/NEJMoa0706482
pubmed: 17982182
Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361:1045–57.
doi: 10.1056/NEJMoa0904327
pubmed: 19717846
Piccolo R, Magnani G, Ariotti S, et al. Ischaemic and bleeding outcomes in elderly patients undergoing a prolonged versus shortened duration of dual antiplatelet therapy after percutaneous coronary intervention: insights from the PRODIGY randomised trial. EuroIntervention. 2017;13:78–86.
doi: 10.4244/EIJ-D-16-00497
pubmed: 28044986
Chandrasekhar J, Baber U, Sartori S, et al. Prasugrel use and clinical outcomes by age among patients undergoing PCI for acute coronary syndrome : from the PROMETHEUS study. Clin Res Cardiol. 2020;109:725–34.
doi: 10.1007/s00392-019-01561-4
pubmed: 31915997
Gale CP, Cattle BA, Woolston A, et al. Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The Myocardial Ischaemia National Audit Project 2003–2010. Eur Heart J. 2012;33:630–9.
doi: 10.1093/eurheartj/ehr381
pubmed: 22009446
Rosengren A, Wallentin L, Simoons M, et al. Age, clinical presentation, and outcome of acute coronary syndromes in the Euroheart acute coronary syndrome survey. Eur Heart J. 2006;27:789–95.
doi: 10.1093/eurheartj/ehi774
pubmed: 16464911
Zaman MJ, Stirling S, Shepstone L, et al. The association between older age and receipt of care and outcomes in patients with acute coronary syndromes: a cohort study of the Myocardial Ischaemia National Audit Project (MINAP). Eur Heart J. 2014;35:1551–8.
doi: 10.1093/eurheartj/ehu039
pubmed: 24644310
Marcucci R, Patti G, Calabrò P, et al. Antiplatelet treatment in acute coronary syndrome patients: real-world data from the START-Antiplatelet Italian Registry. PLoS ONE. 2019;14:e219676.
doi: 10.1371/journal.pone.0219676
pubmed: 31306454
pmcid: 6629086
Gimbel M, Qaderdan K, Willemsen L, et al. Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with non-ST-elevation acute coronary syndrome (POPular AGE): the randomised, open-label, non-inferiority trial. Lancet. 2020;395:1374–81.
doi: 10.1016/S0140-6736(20)30325-1
pubmed: 32334703
Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials. Circulation. 2011;123:2736–47.
doi: 10.1161/CIRCULATIONAHA.110.009449
pubmed: 21670242
Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018;138:e618–51.
doi: 10.1161/CIR.0000000000000617
pubmed: 30571511
Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials. Circulation. 2007;115:2344–51.
doi: 10.1161/CIRCULATIONAHA.106.685313
pubmed: 17470709
Fox KAA, Dabbous OH, Goldberg RJ, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;333:1091.
doi: 10.1136/bmj.38985.646481.55
pubmed: 17032691
pmcid: 1661748
Urban P, Mehran R, Colleran R, et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J. 2019;40:2632–53.
doi: 10.1093/eurheartj/ehz372
pubmed: 31116395
pmcid: 6736433
Yeh RW, Secemsky EA, Kereiakes DJ, et al. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA. 2016;315:1735–49.
doi: 10.1001/jama.2016.3775
pubmed: 27022822
pmcid: 5408574
Costa F, van Klaveren D, James S, et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017;389:1025–34.
doi: 10.1016/S0140-6736(17)30397-5
pubmed: 28290994
Szummer K, Wallentin L, Lindhagen L, et al. Relations between implementation of new treatments and improved outcomes in patients with non-ST-elevation myocardial infarction during the last 20 years: experiences from SWEDEHEART registry 1995 to 2014. Eur Heart J. 2018;39:3766–76.
doi: 10.1093/eurheartj/ehy554
pubmed: 30239671
Llaó I, Ariza-Solé A, Sanchis J, et al. Invasive strategy and frailty in very elderly patients with acute coronary syndromes. EuroIntervention. 2018;14:e336–42.
doi: 10.4244/EIJ-D-18-00099
pubmed: 29616624
Tegn N, Abdelnoor M, Aaberge L, et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. Lancet. 2016;387:1057–65.
doi: 10.1016/S0140-6736(15)01166-6
pubmed: 26794722
Husted S, James S, Becker RC, et al. Ticagrelor versus clopidogrel in elderly patients with acute coronary syndromes: a substudy from the prospective randomized PLATelet inhibition and patient Outcomes (PLATO) trial. Circ Cardiovasc Qual Outcomes. 2012;5:680–8.
doi: 10.1161/CIRCOUTCOMES.111.964395
pubmed: 22991347