Abstract
Background: An increasing proportion of patients with acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI) are classified as elderly (aged ≥70 years). The glycoprotein IIb/IIIa inhibitor abciximab is known to reduce adverse outcomes in patients aged <70 years with high-risk ACS undergoing PCI, but conflicting findings relating to its effects in the elderly have been reported.
Objective: The aim of this study was to evaluate the effect of abciximab in elderly high-risk ACS patients undergoing PCI.
Methods: From our dedicated PCI registry we identified 2068 ACS patients with high-risk lesions that were treated with PCI. Baseline data were collected prospectively. All-cause mortality, target vessel revascularization (TVR), myocardial infarction (MI), and the combination of these were primary study endpoints. All endpoints within 1 year after PCI were registered and validated. The population was subsequently stratified according to age and use of abciximab.
Results: Elderly patients constituted 42% of the total population. They presented with more co-morbidities, were less frequently treated with abciximab and had a higher risk of reaching the combined endpoint and higher all-cause mortality than younger patients. The age/abciximab stratified analysis revealed no effect of abciximab on any of the endpoints in elderly patients (combined endpoint: no abciximab 22.6% vs abciximab 23.4%, p = 0.85; all-cause mortality: no abciximab 15.4% vs abciximab 15.9%, p = 0.91; TVR: no abciximab 3.4% vs abciximab 5.5%, p = 0.21; MI: no abciximab 7.0% vs abciximab 8.5%, p = 0.54), whereas all-cause mortality and the risk of reaching the combined endpoint were significantly reduced in younger patients (combined endpoint: no abciximab 14.0% vs abciximab 9.4%, p = 0.03; all-cause mortality: no abciximab 4.5% vs abciximab 1.7%, p = 0.02; TVR: no abciximab 5.5% vs abciximab 4.3%, p = 0.39; MI: no abciximab 7.2% vs abciximab 6.6%, p = 0.80). These findings were confirmed in our adjusted analyses.
Conclusions: In this large observational study we found no benefit of abciximab treatment in elderly high-risk ACS patients who underwent PCI. These findings should be taken into consideration when deciding on the treatment strategy for elderly ACS patients undergoing PCI.
References
Bach RG, Cannon CP, Weintraub WS, et al. The effect of routine, early invasive management on outcome for elderly patients with non-ST-segment elevation acute coronary syndromes. Ann Intern Med 2004 Aug 3; 141(3): 186–95
Thompson RC, Holmes Jr DR. Percutaneous transluminal coronary angioplasty in the elderly. Clin Geriatr Med 1996 Feb; 12(1): 181–94
Alexander KP, Newby LK, Cannon CP, et al. Acute coronary care in the elderly, part I: non-ST-segment-elevation acute coronary syndromes — a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 2007 May 15; 115(19): 2549–69
CAPTURE Investigators. Randomised placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE Study. Lancet 1997 May 17; 349(9063): 1429–35
EPIC Investigators. Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty: the EPIC Investigation. N Engl J Med 1994 Apr 7; 330(14): 956–61
EPILOG Investigators. Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization: the EPILOG Investigators. N Engl J Med 1997 Jun 12; 336(24): 1689–96
EPISTENT Investigators. Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade. Lancet 1998 Jul 11; 352(9122): 87–92
Kastrati A, Mehilli J, Neumann FJ, et al. Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pre-treatment: the ISAR-REACT 2 randomized trial. JAMA 2006 Apr 5; 295(13): 1531–8
Iversen A, Pedersen S, Joens C, et al. Impact of abciximab in diabetic patients with acute coronary syndrome who undergo percutaneous coronary intervention: results from a high-volume single center registry. J Invasive Cardiol 2011 Jan; 23(1): 21–6
De Luca G, Navarese E, Marino P. Risk profile and benefits from Gp IIb-IIIa inhibitors among patients with ST-segment elevation myocardial infarction treated with primary angioplasty: a meta-regression analysis of randomized trials. Eur Heart J 2009 Nov; 30(22): 2705–13
Lee PY, Alexander KP, Hammill BG, et al. Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA 2001 Aug 8; 286(6): 708–13
Cannon CP. Elderly patients with acute coronary syndromes: higher risk and greater benefit from antithrombotic and interventional therapies. Am J Geriatr Cardiol 2000 Oct; 9(5): 265–70
Galasso G, Piscione F, Furbatto F, et al. Abciximab in elderly with acute coronary syndrome invasively treated: effect on outcome. Int J Cardiol 2008 Nov 28; 130(3): 380–5
Guagliumi G, Stone GW, Cox DA, et al. Outcome in elderly patients undergoing primary coronary intervention for acute myocardial infarction: results from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. Circulation 2004 Sep 21; 110(12): 1598–604
Mak KH, Effron MB, Moliterno DJ. Platelet glycoprotein IIb/IIIa receptor antagonists and their use in elderly patients. Drugs Aging 2000 Mar; 16(3): 179–87
Ndrepepa G, Kastrati A, Mehilli J, et al. Age-dependent effect of abciximab in patients with acute coronary syndromes treated with percutaneous coronary interventions. Circulation 2006 Nov 7; 114(19): 2040–6
Sinnaeve PR, Huang Y, Bogaerts K, et al. Age, outcomes, and treatment effects of fibrinolytic and antithrombotic combinations: findings from Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT)-3 and ASSENT-3 PLUS. Am Heart J 2006 Oct; 152(4): 684–9
Ryan TJ, Faxon DP, Gunnar RM, et al. Guidelines for percutaneous transluminal coronary angioplasty: a report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation 1988 Aug; 78(2): 486–502
Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007 May 1; 115(17): 2344–51
Madsen M, Davidsen M, Rasmussen S, et al. The validity of the diagnosis of acute myocardial infarction in routine statistics: a comparison of mortality and hospital discharge data with the Danish MONICA registry. J Clin Epidemiol 2003 Feb; 56(2): 124–30
Prati F, Kwiatkowski P, Caroselli C, et al. Use of abciximab prevents microcirculatory impairment in patients treated with coronary angioplasty for unstable angina: results of a prospective randomized study. Catheter Cardiovasc Interv 2005 Oct; 66(2): 165–9
Brandes RP, Fleming I, Busse R. Endothelial aging. Cardiovasc Res 2005 May 1; 66(2): 286–94
Taddei S, Virdis A, Ghiadoni L, et al. Age-related reduction of NO availability and oxidative stress in humans. Hypertension 2001 Aug; 38(2): 274–9
O’Donnell CJ, Larson MG, Feng D, et al. Genetic and environmental contributions to platelet aggregation: the Framingham heart study. Circulation 2001 Jun 26; 103(25): 3051–6
Tofler GH, Massaro J, Levy D, et al. Relation of the prothrombotic state to increasing age (from the Framingham Offspring Study). Am J Cardiol 2005 Nov 1; 96(9): 1280–3
Krumholz HM, Chen J, Wang Y, et al. Comparing AMI mortality among hospitals in patients 65 years of age and older: evaluating methods of risk adjustment. Circulation 1999 Jun 15; 99(23): 2986–92
Hordijk-Trion M, Lenzen M, Wijns W, et al. Patients enrolled in coronary intervention trials are not representative of patients in clinical practice: results from the Euro Heart Survey on Coronary Revascularization. Eur Heart J 2006 Mar; 27(6): 671–8
Avezum A, Makdisse M, Spencer F, et al. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 2005 Jan; 149(1): 67–73
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No sources of funding were used to conduct this study or prepare this article. There are no financial or other conflicts of interest for any of the authors.
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Iversen, A.Z., Galatius, S., Pedersen, S. et al. Impact of Abciximab in Elderly Patients with High-Risk Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Drugs Aging 28, 369–378 (2011). https://doi.org/10.2165/11587170-000000000-00000
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DOI: https://doi.org/10.2165/11587170-000000000-00000