Antiplatelet Therapy in Non-ST-Segment Elevation Acute Coronary Syndromes in Elderly Patients. POPular AGE Hypothesis

Abstract

Background: The POPular AGE study demonstrated that in patients over 70 years of age clopidogrel would be the P2Y12 receptor inhibitor (P2Y12i) of choice due to its association with lower bleeding incidence and no difference in ischemic events. Objective: We analyzed the safety and efficacy of different treatment regimens with P2Y12i, in patients ≥70 years with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) to test the “POPular AGE” hypothesis in the real world. Methods: This subanalysis of the prospective BUENOS AIRES I registry analyzed data corresponding to 1100 patients from 21 medical centers in Buenos Aires, Argentina, followed-up for 15 months. We considered the subgroup of patients ≥70 years, stratified according to the P2Y12i indicated at discharge. Results: This subgroup had a high burden of comorbidities, with 85.1% hypertension, 30.3% diabetes mellitus, and 43.2% chronic kidney disease. Patients treated with ticagrelor/prasugrel (n=54) presented with higher prevalence of active smoking, less atrial fibrillation and lower CRUSADE score, with no differences in the GRACE score, compared whit those treated with clopidogrel (n=286). At the 15-month follow-up, no significant differences were observed in the BARC ≥2 bleeding rate, with more events in the clopidogrel group, although without statistical significance, (25.4% vs. 18.2%; p=0.327) and a benefit in the incidence of major adverse cardiovascular events (MACE) in the ticagrelor/prasugrel treatment group (18.6% vs 36.3%, p= 0.023). Conclusions: In adequately selected patients with NSTE-ACS ≥70 years, treatment with Ticagrelor/prasugrel could be a safe and effective strategy.