Advanced age, antithrombotic strategy, and bleeding in non-ST-segment elevation acute coronary syndromes: results from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.
OBJECTIVE
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.
Lopes
Renato D
RD
Duke University Medical Center, Durham, North Carolina, USA. renato.lopes@duke.edu
Alexander
Karen P
KP
Manoukian
Steven V
SV
Bertrand
Michel E
ME
Feit
Frederick
F
White
Harvey D
HD
Pollack
Charles V
CV
Hoekstra
James
J
Gersh
Bernard J
BJ
Stone
Gregg W
GW
Ohman
E Magnus
EM
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D000368:Aged; D000375:Aging / Q000502:physiology*; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000009:adverse effects; D001026:Coronary Artery Bypass; D017984:Enoxaparin / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced*; D006493:Heparin / Q000009:adverse effects; D006629:Hirudins / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000009:adverse effects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011994:Recombinant Proteins / Q000009:adverse effects; D013927:Thrombosis / Q000517:prevention & control*; D016896:Treatment Outcome
D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin