Lopes RD， Alexander KP， Manoukian SV， Bertrand ME， Feit F， White HD， Pollack CV Jr， Hoekstra J， Gersh BJ， Stone GW， Ohman EM.
Duke University Medical Center， Durham， North Carolina， USA. renato.lopes@duke.edu
Abstract
OBJECTIVES: This study sought to evaluate the impact of age on outcomes in patients with moderate- and high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) enrolled in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.
BACKGROUND: Aging-associated changes in physiology and metabolism may alter the risk and benefit of therapeutic strategies from that observed in younger people.
METHODS: We performed a pre-specified analysis of 30-day and 1-year outcomes in 4 age groups， overall and among those undergoing percutaneous coronary intervention (PCI).
RESULTS: Of 13，819 patients in the ACUITY trial， 3，655 (26.4%) were <55 years of age， 3，940 (28.5%) were 55 to 64 years of age， 3，783 (27.4%) were 65 to 74 years of age， and 2，441 (17.7%) were > or =75 years of age. Older patients had more cardiovascular risk factors and had a higher acuity at presentation. Patients age > or =75 years treated with bivalirudin alone had similar ischemic outcomes， but significantly lower rates of bleeding compared with those treated with heparin and glycoprotein IIb/IIIa inhibitors overall and in the PCI subset. The number needed to treat with bivalirudin alone to avoid 1 major bleeding event was lower in this age group (23 overall and 16 for PCI-treated patients) than in any other.
CONCLUSIONS: Ischemic and bleeding complications after NSTE-ACS increase with age. Although ischemic event rates are not statistically different with either bivalirudin alone or a heparin plus glycoprotein IIb/IIIa inhibitor， bleeding complications are significantly less frequent with bivalirudin alone. Because of the substantial risk of bleeding in patients age > or =75 years， the number needed to treat to avoid 1 major bleeding event using bivalirudin alone was the lowest in the elderly group， especially among those undergoing PCI.