Abstract
Purpose
Higher risk of bleeding with ticagrelor over clopidogrel in elderly patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) has been suggested. We assessed the incidence of major bleedings (MB), reinfarction (re-MI), and all-cause death to evaluate safety and efficacy of ticagrelor versus clopidogrel in such population.
Methods
Real-world registries RENAMI and BleeMACS were merged. The pooled cohort was divided into two groups, clopidogrel versus ticagrelor. Statistical analysis considered patients <75 versus ≥75 years old. Endpoints were BARC 3–5 MB, re-MI, and all-cause death at 1-year follow-up. The study included 16,653 patients (13,153 < 75 and 3500 ≥ 75 years). Ticagrelor was underused in elderly patients (16.3% versus 20.8%, P < 0.001). Using propensity score matching (PSM), two treatment groups of 1566 patients were included in the final analysis.
Results
Ticagrelor was able to prevent re-MI (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.2–0.6; P < 0.001) and all-cause death (HR, 0.60; 95% CI, 0.4–0.9; P = 0.026) irrespective of age. In patients ≥75 years, ticagrelor reduced all-cause death (HR, 0.32; 95% CI, 0.1–0.8; P = 0.012) and re-MI (HR, 0.25; 95% CI, 0.1–1.1, P = 0.072). Moreover, even with the limit of the low number of events, ticagrelor did not significantly increase the incidence of MB (HR, 1.49; 95% CI, 0.70–3.0; P = 0.257). At multiple Cox regression, age (HR, 1.03; 95% CI, 1.02–1.05; P < 0.001) resulted an independent risk factor for bleeding.
Conclusion
In our study, reflecting the results from two large retrospective, real-world registries, Ticagrelor did not significantly increase MB compared with clopidogrel in elderly patients with ACS treated with PCI, while significantly improving 1-year survival. Further studies on elderly patients are suggested.
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Data Availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Code Availability
Not applicable.
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Acknowledgements
Dr. Federico Giacobbe was of great help in collecting data for the revision answers.
Editorial assistance for the linguistic review of this article was provided by Edra S.p.A, and unconditionally funded by AstraZeneca.
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EC, MB, and AC contributed to the supervision, concept, design, and revision of the article. All the other authors contributed to the design and revision of the article. All authors gave final approval to submit the article for publication.
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Bianco, M., Careggio, A., Biolè, C.A. et al. Ticagrelor or Clopidogrel After an Acute Coronary Syndrome in the Elderly: A Propensity Score Matching Analysis from 16,653 Patients Treated with PCI Included in Two Large Multinational Registries. Cardiovasc Drugs Ther 35, 1171–1182 (2021). https://doi.org/10.1007/s10557-021-07213-y
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DOI: https://doi.org/10.1007/s10557-021-07213-y