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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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28. Risk Factors and Prevention
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Ticagrelor versus clopidogrel in elderly patients with myocardial infarction: a real-life experience
Session:
Posters 4 - Écran 2 - Doença Coronária
Speaker:
Ana Rita Pereira
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Ana Rita F. Pereira; Ana I. Marques; Sofia Alegria; Alexandra Briosa; Daniel Sebaiti; Inês Rangel; Rita Calé; Cristina Dantas Martins; Helder Pereira; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><strong>Introduction: </strong>Dual anti-platelet therapy (DAPT) with ticagrelor (T) is recommended in patients (pts) with myocardial infarction (MI), due to its long-term benefit over clopidogrel (C). Elderly pts have both higher risk of recurrent ischemic events and higher risk of bleeding but there is few evidence for this cohort of pts.</p> <p><strong>Objectives: </strong>To compare the short-term safety profile of DAPT with T versus (vs) C in elderly pts treated with percutaneous coronary intervention (PCI) after MI. To determine the evolution of this therapy prescription over the last years.</p> <p><strong>Methods: </strong>From a retrospective multicenter national registry, pts with MI treated with PCI, between January 2011 and October 2018, were selected. These pts were divided according to age (< 75 vs ≥ 75 years). A detailed comparison between DAPT with T vs C was performed in the elderly group. Pts under triple antithrombotic therapy at hospital discharge were excluded. The safety profile was evaluated by the occurrence of major hemorrhage, need for red blood cell transfusion and all-cause death during hospital stay.</p> <p><strong>Results: </strong>Of a total of 5847 pts, 1332 (22.8%) were age ≥ 75 years (mean age 81 ± 4 years; 61.1% male). In both groups (figure), there was a progressive increase in T prescription over the years. However, the interception point of the prescription curves occurred 1 year later for elderly pts and the highest prescription proportion (observed in 2018) was significantly lower in this group (88% vs 69%, p < 0.01). Non-ST segment MI diagnosis (OR 0.9, 95%CI 0.5-0.9, p = 0.01), dyspnea as predominant initial symptom (OR 0.35, 95%CI 0.1-0.9, p = 0.02) and previous vascular peripheral disease (OR 0.5, 95%CI 0.3-0.9, p = 0.03) were independent predictors for C prescription in the elderly group. No other factors influenced the DAPT choice, such as, previous kidney disease or bleeding, creatinine or hemoglobin values and the number or type of vessels with coronary disease. Regarding safety profile, there were no differences between C and T [major hemorrhage (p = 0.56), need for transfusion (p = 0.11) and death (p > 0.99)].</p> <p><strong>Conclusions: </strong>In this real-life context, there was a significantly lower prescription of T in elderly group. Several clinical factors, not related to predictors of validated bleeding risk scores, influenced the DAPT choice in this subgroup. No difference was observed in short-term safety profile between the 2 drugs. Thus, prescription of T in elderly should be rethought, in order to provide them with the best long-term benefit already demonstrated by large randomized trials.</p>
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