Prospective application of a bleeding and ischemic risks-adjusted antithrombotic protocol in elderly patients revascularized with everolimus-eluting stents: EPIC05-Sierra75 study
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 E. Gomez Menchero
Eladio Galindo Fernández
Juan G. Córdoba Soriano
Raymundo Ocaranza
Eduardo Arroyo Úcar
Koldobika Garcia San Roman
Silvio Leal
Ginés Martínez Cáceres
Jose A Linares Vicente
Georgina Fuertes Ferre
Xavier Carrillo
Juan C. Rama Merchán
Catia Costa
Juan Sanchis
Renato Fernandes
Alberto Rodrigues
Jose M Vegas Valle
Hélder Pereira
Armando Perez de Prado
1.Cardiology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain2.Cardiology Department, Hospital Universitario San Juan, Alicante, Spain3.Cardiology Department, Complejo Hospitalario Uni-versitario de Albacete, Albacete, Spain4.Cardiology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain5.Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain6.Cardiology Department, Hospital Clinico Universitario de Santiago, CIBERCV, Santiago de Compostela, Spain7.Cardiology Department, Hospital Universitario de Cruces, Bilbao, Spain8.Cardiology Department, Hospital Regional Universitario de Málaga, Malaga, Spain9.Cardiology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain10.Cardiology Department, Hospital Alvaro Cunqueiro, Vigo, Spain11.Cardiology Department, Hospital Juan Ramon Jimenez, Huelva, Spain12.Cardiology Department, Hospital Universitario de Badajoz, Badajoz, Spain13.Cardiology Department, Hospital Universitario Lucus Augusti, Lugo, Spain14.Cardiology Department, Hospital de Torrevieja/Vinalopó, Ribera Salud, Torrevieja, Spain15.Cardiology Department, Hospital Santa Cruz, Lisboa, Portugal16.Cardiology Depart-ment, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain17.Cardiology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain18.Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain19.Cardi-ology Department, Hospital de Merida, Merida, Spain20.Cardiology Department, Hospital S?o Bernardo, Setúbal, Portugal21.Cardiology Department, Hospital Clinico Universitario de Valencia, Universidad de Valencia, CIBERCV, Valencia, Spain22.Cardiology Department, Hospital do Espirito Santo, Evora, Portugal23.Cardiology Department, Centro Hospitalar de Vilanova de Gaia, Vilanova de Gaia, Portugal24.Cardiology Department, Hospital de Cabue?es, Gijon, Spain25.Cardiology Department, Hospital Garcia de Orta, Almada, Portugal26.Cardiology Department, Complejo Asistencial Universitario de León, Leon, Spain
摘要：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.
机标关键词：applicationprotocolstudywithantithromboticbleedingelderlyeluting
论文发表日期：2022-05-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：13( 354-366 )