Abstract
Elderly patients treated with percutaneous coronary intervention (PCI) have a higher risk of both ischemic and bleeding complications than younger patients. However, few studies have reported how genetic information of elderly patients treated with PCI affects clinical outcomes. We investigated the impact of genetic variants on clinical outcomes in elderly patients. Correlations between single-nucleotide polymorphisms (CYP2C19 and P2Y12 receptor gene G52T polymorphism) and clinical outcomes were analyzed in 811 elderly patients (≥75 years of age) from a prospective multicenter registry. The primary endpoint was a composite of myocardial infarction and death. Secondary endpoints were an individual event of death, cardiac death, myocardial infarction, stent thrombosis, target lesion revascularization, stroke, and major bleeding (Bleeding Academic Research Consortium ≥3). Regarding CYP2C19, patients with poor metabolizers had a significantly higher risk for the primary endpoint (hazard ratio [HR] 2.43; 95% confidence interval [95% CI] 1.12–5.24; p=0.024) and secondary endpoints (death and cardiac death). Regarding P2Y12 G52T, the TT group had a significantly higher occurrence of major bleeding than the other groups (HR 3.87; 95% CI 1.41–10.68; p=0.009). In conclusion, poor metabolizers of CYP2C19 and TT groups of P2Y12 G52T may be significant predictors of poor clinical outcomes in elderly patients.
Highlights
The number of elderly patients treated with percutaneous coronary intervention (PCI) for coronary artery disease is increasing [1, 2]
This study showed that elderly patients with poor metabolizers, which require adjusting the antiplatelet therapy, had worse clinical outcomes than the normal and intermediate metabolizer groups when the same dual antiplatelet therapy (DAPT) treatment was applied
Our results revealed that worse clinical outcomes might occur in elderly patients who are poor metabolizers, as the platelet dysfunction caused by biological senescence from old age and the intrinsic risk factors caused by genetic polymorphisms interact with each other
Summary
The number of elderly patients treated with percutaneous coronary intervention (PCI) for coronary artery disease is increasing [1, 2]. Patients who undergo PCI have a higher risk of ischemic events and bleeding complications than younger patients and— —a higher mortality rate [5]. Numerous general population studies have been conducted on the optimal dual antiplatelet therapy (DAPT) strategy to reduce ischemic and bleeding risk [6]. A tailored DAPT strategy based on genetic variation has been proposed [7,8,9]. Few studies have addressed tailored DAPT based on genetic variation in elderly patients. This multicenter, prospective, observational study investigated the associations between genetic variants and clinical outcomes in elderly patients after PCI
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