TY - JOUR
T1 - In-hospital outcomes of dual loading antiplatelet therapy in patients 75 years and older with acute coronary syndrome undergoing percutaneous coronary intervention
T2 - Findings from the CCC-ACS (Improving Care for Cardiovascular Disease in China-acute coronary syndrome) project
AU - on behalf of the CCC-ACS Investigators
AU - Zhao, Guanqi
AU - Zhou, Mengge
AU - Ma, Changsheng
AU - Huo, Yong
AU - Smith, Sidney C.
AU - Fonarow, Gregg C.
AU - Ge, Junbo
AU - Han, Yaling
AU - Liu, Jing
AU - Hao, Yongchen
AU - Liu, Jun
AU - Wang, Xiao
AU - Taubert, Kathryn A.
AU - Morgan, Louise
AU - Zhao, Dong
AU - Nie, Shaoping
AU - Li, Bao
AU - Xu, Biao
AU - Han, Guangshu
AU - Li, Bin
AU - Liu, Bin
AU - Yu, Bo
AU - Wang, Changqian
AU - Gao, Chuanyu
AU - Lai, Chunlin
AU - Bin, Cui
AU - Huang, Lan
AU - Wu, Di
AU - Tang, Fakuan
AU - Xiao, Jun
AU - Ma, Genshan
AU - Tao, Guizhou
AU - Li, Guoqing
AU - Fu, Guosheng
AU - Li, Hongwei
AU - Wang, Honhju
AU - Wang, Huifeng
AU - Ye, Jianfeng
AU - Li, Jianhao
AU - Jiang, Jie
AU - Wang, Jingfeng
AU - Chen, Jiyan
AU - Liu, Junming
AU - Li, Junxia
AU - Li, Lang
AU - Jiang, Li
AU - Meng, Lijun
AU - Li, Ling
AU - Tao, Ling
AU - Yuan, Zuyi
N1 - Publisher Copyright:
© 2018 The Authors.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Background--Elderly patients with acute coronary syndrome (ACS) are at high risk for ischemic and bleeding events. This study aimed to evaluate the clinical effectiveness and safety of dual loading antiplatelet therapy for patients 75 years and older undergoing percutaneous coronary intervention for ACS. Methods and Results--The Improving Care for Cardiovascular Disease in China-ACS project was a collaborative study of the American Heart Association and Chinese Society of Cardiology. A total of 5887 patients 75 years and older with ACS who had percutaneous coronary intervention and received dual antiplatelet therapy with aspirin and P2Y12 inhibitors (clopidogrel or ticagrelor) between November 2014 and June 2017 were enrolled. The primary effectiveness and safety outcomes were in-hospital major adverse cardiovascular events and major bleeding. Hazard ratios (HRs) of in-hospital outcomes with different loading statuses of antiplatelet therapy were estimated using Cox proportional hazard models with multivariate adjustment. A propensity score-matched analysis was also conducted. Compared with patients receiving a dual nonloading dose, patients taking a dual loading dose had increased risks of both major adverse cardiovascular events (HR, 1.66, 95% confidence interval, 1.13-2.44; [P=0.010]) and major bleeding (HR, 2.34, 95% confidence interval, 1.75-3.13; [P < 0.001]). Among 3284 propensity score-matched patients, a dual loading dose was associated with a 1.36-fold risk of major adverse cardiovascular events (HR, 1.36; 95% confidence interval, 0.88-2.11 [P=0.168]) and a 2.08-fold risk of major bleeding (HR, 2.08; 95% confidence interval, 1.47-2.93 [P < 0.001]). Conclusions--A dual loading dose of antiplatelet therapy was associated with increased major bleeding risk but not with decreased major adverse cardiovascular events risk among patients 75 years and older undergoing percutaneous coronary intervention for ACS in China.
AB - Background--Elderly patients with acute coronary syndrome (ACS) are at high risk for ischemic and bleeding events. This study aimed to evaluate the clinical effectiveness and safety of dual loading antiplatelet therapy for patients 75 years and older undergoing percutaneous coronary intervention for ACS. Methods and Results--The Improving Care for Cardiovascular Disease in China-ACS project was a collaborative study of the American Heart Association and Chinese Society of Cardiology. A total of 5887 patients 75 years and older with ACS who had percutaneous coronary intervention and received dual antiplatelet therapy with aspirin and P2Y12 inhibitors (clopidogrel or ticagrelor) between November 2014 and June 2017 were enrolled. The primary effectiveness and safety outcomes were in-hospital major adverse cardiovascular events and major bleeding. Hazard ratios (HRs) of in-hospital outcomes with different loading statuses of antiplatelet therapy were estimated using Cox proportional hazard models with multivariate adjustment. A propensity score-matched analysis was also conducted. Compared with patients receiving a dual nonloading dose, patients taking a dual loading dose had increased risks of both major adverse cardiovascular events (HR, 1.66, 95% confidence interval, 1.13-2.44; [P=0.010]) and major bleeding (HR, 2.34, 95% confidence interval, 1.75-3.13; [P < 0.001]). Among 3284 propensity score-matched patients, a dual loading dose was associated with a 1.36-fold risk of major adverse cardiovascular events (HR, 1.36; 95% confidence interval, 0.88-2.11 [P=0.168]) and a 2.08-fold risk of major bleeding (HR, 2.08; 95% confidence interval, 1.47-2.93 [P < 0.001]). Conclusions--A dual loading dose of antiplatelet therapy was associated with increased major bleeding risk but not with decreased major adverse cardiovascular events risk among patients 75 years and older undergoing percutaneous coronary intervention for ACS in China.
KW - Acute coronary syndrome
KW - Antiplatelet therapy
KW - Elderly
KW - Loading dose
KW - Percutaneous coronary intervention
UR - https://www.scopus.com/pages/publications/85044856129
U2 - 10.1161/JAHA.117.008100
DO - 10.1161/JAHA.117.008100
M3 - 文章
C2 - 29602767
AN - SCOPUS:85044856129
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 7
M1 - e008100
ER -
可持续发展目标 3 良好健康与福祉