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Prospective application of a bleeding and ischemic risks-adjusted antithrombotic protocol in elderly patients revascularized with everolimus-eluting stents:EPIC05-Sierra75 study

引用

Journal of Geriatric Cardiology 2022年第5期19卷 354-366页

作者： Jose M de la Torre Hernandez Ramon Lopez Palop Jesus M Jimenez Mazuecos Pilar Carrillo Sáez Alejandro Gutierez-Barrios Eduardo Pinar Belen Cid Luis fernandez Tamara Garcia Camarero Cristóbal Urbano-Carrillo Juan F Oteo Dominguez Victor A Jimenez Diaz Antonio EGomez Menchero Eladio Galindo fernández juan GCórdoba Soriano Raymundo Ocaranza Eduardo ArroyoÚcar Koldobika Garcia San Roman Silvio Leal Ginés Martínez Cáceres Jose A Linares Vicente Georgina fuertes ferre Xavier Carrillo juan CRama Merchán Catia Costa juan Sanchis Renato fernandes Alberto Rodrigues Jose M Vegas Valle Hélder Pereira Armando Perez de Prado Cardiology Department Hospital Universitario Marqués de ValdecillaIDIVALSantanderSpain Cardiology Department Hospital Universitario San JuanAlicanteSpain Cardiology Department Complejo Hospitalario Universitario de AlbaceteAlbaceteSpain Cardiology Department Hospital Universitario Puerta del MarCadizSpain Cardiology Department Hospital Clínico Universitario Virgen de la ArrixacaMurciaSpain Cardiology Department Hospital Clinico Universitario de SantiagoCIBERCVSantiago de CompostelaSpain Cardiology Department Hospital Universitario de CrucesBilbaoSpain Cardiology Department Hospital Regional Universitario de MálagaMalagaSpain Cardiology Department Hospital Universitario Puerta de HierroMadridSpain Cardiology Department Hospital Alvaro CunqueiroVigoSpain Cardiology Department Hospital Juan Ramon JimenezHuelvaSpain Cardiology Department Hospital Universitario de BadajozBadajozSpain Cardiology Department Hospital Universitario Lucus AugustiLugoSpain Cardiology Department Hospital de Torrevieja/VinalopóRibera SaludTorreviejaSpain Cardiology Department Hospital Santa CruzLisboaPortugal Cardiology Department Hospital Clínico Universitario Lozano BlesaZaragozaSpain Cardiology Department Hospital Universitario Miguel ServetZaragozaSpain Cardiology Department Hospital Germans Trias i PujolBadalonaSpain Cardiology Department Hospital de MeridaMeridaSpain Cardiology Department Hospital São BernardoSetúbalPortugal Cardiology Department Hospital Clinico Universitario de ValenciaUniversidad de ValenciaCIBERCVValenciaSpain Cardiology Department Hospital do Espirito SantoEvoraPortugal Cardiology Department Centro Hospitalar de Vilanova de GaiaVilanova de GaiaPortugal Cardiology Department Hospital de CabueñesGijonSpain Cardiology Department Hospital Garcia de OrtaAlmadaPortugal Cardiology Department Complejo Asistencial Universitario de LeónLeonSpain

OBJECTIVES Elderly patients show a higher incidence of ischemic and bleeding events after percutaneous transluminal coron-ary intervention(PCI).We sought to investigate outcomes in elderly patients treated with antithrombotic strategy guided by bleeding and ischemic risks after revascularization with last generation everolimus-eluting stent(EES).METHODS Prospective multicenter registry including patients over 75 years revascularized with EES and antithrombotic ther-apy guided by clinical presentation,PCI complexity and PRECISE DAPT score.Co-primary safety endpoints were:(1)composite of cardiac death,myocardial infarction and stent thrombosis and;(2)bleeding(BARC 2-5).Primary efficacy endpoint was target lesion revascularization.A matched group of patients revascularized with current drug-eluting stents and no such tailored antith-rombotic therapy was used as control.RESULTS finally,1064 patients were included in SIERRA-75 cohort,80.8±4.2 years,36.6%women,71%acute coronary syn-dromes(ACS)and 53.6%complex PCI.Co-primary safety endpoint of major adverse cardiovascular events was met in 6.2%,co-primary safety endpoint of bleeding in 7.8%and primary efficacy endpoint of TKLR in 1.5%.The multivariable adjusted model showed no significant association of the prescribed short/long dual antiplatelet therapy(DAPT)durations with any endpoint suggesting a well tailored therapy.No stent thrombosis reported in the subgroup with 1-3 months DAPT duration.As compared to control group,bleeding BARC 2-5 was significantly lower in SIERRA-75 group(7.4%vs.10.2%,P=0.04)as well as the net safety-efficacy endpoint(14.3%vs.18.5%,P=0.02).CONCLUSIONS In elderly population,the application of this risks-adjusted antithrombotic protocol after revascularization with last generation EES seems to be associated with an improved prognosis in terms of ischemic and bleeding outcomes.

关键词： patients bleeding antithrombotic

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