经皮冠状动脉介入治疗中口服抗凝治疗的老年患者的临床特征、治疗策略和结果：PERSEO注册的事后分析

IF 2.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Geriatric Cardiology Pub Date : 2025-08-28 DOI:10.26599/1671-5411.2025.08.002

Simona Minardi, Salvatore De Rosa, Nicolò Salvi, Giuseppe Andò, Giuseppe Talanas, Claudio D'angelo, Carolina Moretti, Tiziano Maria Mazza, Bernardo Cortese, Giuseppe Musumeci, Andrea Rubboli, Alessandro Sciahbasi

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引用次数: 0

摘要

背景：口服抗凝治疗（OAT）的老年患者经皮冠状动脉介入治疗（PCI）后的抗血栓策略由于缺血和出血风险之间的平衡而存在争议。最近的指南建议早期从三重抗血栓治疗过渡到双重抗血栓治疗，但关于老年患者的数据有限。方法：我们对PERSEO注册人群进行了一项针对年龄的事后分析，旨在比较年龄≥80岁和< 80岁接受OAT治疗并接受PCI支架治疗的患者的临床特征、治疗策略和结果。主要终点是1年随访的净不良临床事件。次要终点包括重大心脑不良事件（MACCE）、重大出血[出血学术研究联盟（BARC） 3-5型]和临床相关出血（BARC 2-5型）。结果：1234例入组患者中，31%的患者年龄≥80岁（84±3岁，76%为男性）。与年轻患者相比，老年患者有更高的合并症，如高血压、贫血或慢性肾脏疾病，心房颤动是OAT的主要适应症。老年患者出院时接受双重抗栓治疗的比例（23%）高于年轻患者（13%）（P < 0.0001）。他们经历了更高的净不良临床事件（38%对21%，P < 0.001）， MACCE(24%对12%，P < 0.001)，以及更高的出血率。具体来说，老年患者的大出血发生率（9% vs. 6%, P = 0.026）和临床相关出血发生率（21% vs. 12%, P < 0.001）显著高于老年患者。结论：接受PCI治疗的老年OAT患者是一个特殊的虚弱人群，尽管抗血栓治疗的积极程度较低，但与年轻患者相比，MACCE和出血的风险更高。

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Clinical characteristics, therapeutic strategies, and outcomes in elderly patients on oral anticoagulant therapy undergoing percutaneous coronary interventions: post-hoc analysis of the PERSEO Registry.

Background: Antithrombotic strategies after percutaneous coronary interventions (PCI) in elderly patients on oral anticoagulant therapy (OAT) are debated due to the balance between ischemic and bleeding risks. Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy, but there are limited data on elderly patients.

Methods: We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features, therapeutic strategies, and outcomes of individuals aged ≥ 80 years and < 80 years who were on OAT and underwent PCI with stent. The primary endpoint was net adverse clinical events at 1-year follow-up. Secondary endpoints included major adverse cardiac and cerebral events (MACCE), major bleeding [Bleeding Academic Research Consortium (BARC) type 3-5], and clinically relevant bleeding (BARC type 2-5).

Results: Among the 1234 patients enrolled, 31% of patients were aged ≥ 80 years (84 ± 3 years, 76% males). Compared to younger patients, elderly patients had higher rates of comorbidities such as hypertension, anaemia or chronic kidney disease, and atrial fibrillation was the leading indication for OAT. Elderly patients were more often discharged on dual antithrombotic therapy (23%) compared to younger patients (13%) (P < 0.0001). They experienced higher net adverse clinical events (38% vs. 21%, P < 0.001), MACCE (24% vs. 12%, P < 0.001), as well as higher bleeding rates. Specifically, rates of major bleeding (9% vs. 6%, P = 0.026), and clinically relevant bleeding (21% vs. 12%, P < 0.001) were significantly higher in elderly patients.

Conclusions: Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.

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来源期刊

Journal of Geriatric Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-GERIATRICS & GERONTOLOGY

CiteScore

3.30

自引率

4.00%

发文量

1161

期刊介绍： JGC focuses on both basic research and clinical practice to the diagnosis and treatment of cardiovascular disease in the aged people, especially those with concomitant disease of other major organ-systems, such as the lungs, the kidneys, liver, central nervous system, gastrointestinal tract or endocrinology, etc.