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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

Abstract: Objectives: Elderly patients show a higher incidence of ischemic and bleeding events after percutaneous transluminal coronary 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 therapy 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 antithrombotic 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 syndromes (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.

 Fuente: Journal of Geriatric Cardiology 2022 May 28;19(5):354-366

 Editorial: Science Press

 Año de publicación: 2022

 Nº de páginas: 13

 Tipo de publicación: Artículo de Revista

 DOI: 10.11909/j.issn.1671-5411.2022.05.009

 ISSN: 1671-5411

 Url de la publicación: https://doi.org/10.11909/j.issn.1671-5411.2022.05.009

Autoría

LÓPEZ PALOP, RAMÓN

JIMÉNEZ MAZUECOS, JESÚS M.

CARRILLO SAEZ, PILAR

GUTIÉRREZ-BARRIOS, ALEJANDRO

PINAR, EDUARDO

CID, BELÉN

FERNÁNDEZ, LUIS

GARCÍA CAMARERO, TAMARA

URBANO-CARRILLO, CRISTOBAL

OTEO DOMINGUEZ, JUAN F.

JIMENEZ DIAZ, VICTOR A.

GOMEZ MENCHERO, ANTONIO E.

GALINDO FERNÁNDEZ, ELADIO

CÓRDOBA SORIANO, JUAN G

OCARANZA, RAYMUNDO

ARROYO ÚCAR, EDUARDO

GARCIA SAN ROMAN, KOLDOBIKA

LEAL, SILVIO

MARTÍNEZ CÁCERES, GINÉS