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Predictors of bleeding in elderly patients with myocardial infarction: data from the real world
Session:
Painel 7 - Doença Coronária 8
Speaker:
Sofia Alegria
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Sofia Alegria; Ana I. Marques; Ana Rita F. Pereira; Daniel Sebaiti; Alexandra Briosa; João Grade Santos; Ana Catarina Gomes; Gonçalo Jácome Morgado; Rita Calé; Cristina Dantas Martins; Inês Rangel; Helder Pereira; Em Nome dos Investigadores do Registo Nacional das Síndromes Coronárias Agudas
Abstract
<p><strong>Background: </strong>Elderly patients are clearly underrepresented in contemporary clinical trials of acute myocardial infarction (MI). This population presents a higher risk of both cardiovascular and bleeding events, making the decision of the antithrombotic strategy particularly challenging.</p> <p><strong>Purpose: </strong>To characterize the antithrombotic therapy used in elderly patients with MI, and to identify predictors of bleeding in this population.</p> <p><strong>Methods:</strong> Retrospective analysis of patients with a diagnosis of MI and age ≥ 75 years included in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between October 2010 and January 2018. Logistic regression analysis was used to identify predictors of major bleeding.</p> <p><strong>Results:</strong> The analysis included 17.868 patients with MI, of which 30.1% with age ≥ 75 years. This population had a mean age of 82±5 years, 57% were male and 36% had a diagnosis of ST-segment elevation MI. On admission, 10% presented with Killip-Kimball class III or IV, 14% were on atrial fibrillation, and the mean hemoglobin and creatinine levels were 13±2 g/dl, and 1.6±1.2 mg/dl, respectively. In comparison with younger patients, the elderly population had higher Grace and Crusade scores (178 vs 139, and 41 vs. 24, respectively). Most elderly patients (74%) underwent coronary angiography, of which 85% were submitted to revascularization (percutaneous in 75%, surgical in 9%, and hybrid in 1%). Regarding antiplatelet therapy, aspirin was used in 96% of patients, clopidogrel in 82%, ticagrelor in 13% (vs 25% of younger patients; p<0.001), and glycoprotein IIb/IIIa inhibitors (GPI) in 11%. Most elderly patients were anticoagulated with enoxaparin (68 vs 56% in younger patients), 22% with unfractionated heparin (vs 30%), and 13% with fondaparinux (vs 14%; p<0.05 for all). Complications were more common in the elderly population, including mechanical complications (1.3 vs 0.5%), atrioventricular block (5 vs 3%), and stroke (1.1 vs 0.6%; p<0.001 for all). Elderly patients had a higher rate of major bleeding events (3 vs 1%), in-hospital death (8 vs 2%), and reinfarction (2 vs.1%; p<0.001 for all).</p> <p>In multivariate logistic regression analysis including all the population, age ≥ 75 years was an independent predictor of in-hospital major bleeding (OR 2.57). In the eldery patients the independent predictors of major bleeding were diastolic blood pressure on admission < 50 mmHg (OR 6.02), maximum creatinine ≥ 2 mg/dl (OR 3.88), and the use of GPI (OR 6.33; p<0.05 for all). There was no association between the use of ticagrelor or previous anticoagulant therapy and the occurrence of major bleeding. </p> <p><strong>Conclusions:</strong> This study reflects the contemporary national reality of the management of elderly patients with MI. Overall, this population has a high risk of major bleeding, but several characteristics are associated with an even higher risk, such as the hemodynamic profile, renal function, and the use of GPI.</p>
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