ABSTRACT
Objective To investigate ADP-induced platelet aggregation rate(ADP-Ag),safety and efficacy of different ticagrelor dosage in elderly patients undergoing PCI. Methods 48 elderly patients aged 60 or older were enrolled. After PCI treatment, the patients received antiplatelet therapy with ticagrelor 90 mg(n=26)or 45 mg (n=22)twice daily. ADP-Ag was measured on day 3 to 7 after initial ticagrelor therapy and compared between the two different-dose ticagrelor groups. ADP-Ag ticagrelor treatment was also compared to measurement if patients were previously taking clopidogrel 75 mg daily. Major adverse cardiovascular events (MACE)and bleeding events were recorded in following 12 months. Results Inhibition of ADP-induced platelet aggregation was greater for ticagrelor 90 mg BID versus 45 mg BID(ADP-Ag(27.88±7.77)% vs.(37.87±2.90)%,P<0.05). During the follow-up period,no gastrointestinal bleedings,cerebral hemorrhage or thrombus events occurred in all patients. In ticagrelor 90 mg BID group,stent-restenosis occurred in 3 patients and they needed to take revascularization therapy. Minimal bleeding events occurred in 4 patients(15.4%)and 1 patient(4.5%) with ticagrelor 90 mg and 45 mg BID treatment,respectively. The ADP-Ag with clopidogrel 75 mg QD treatment previously was(51.18±5.55)%,and declined to(26.87±7.33)% and(38.29±2.65)% after conversion to ticagrelor 90 mg BID and 45 mg BID treatment,respectively. Conclusions Ticagrelor of 90 mg BID or 45 mg BID both inhibited ADP-induced platelet aggregation better than clopidogrel. Ticagrelor 45 mg BID was not inferior to 90 mg BID in preventing MACE and with less minimal bleeding events in elderly patients undergoing PCI.
ABSTRACT
Objective To analyze the risk factors of repeat revascularization after percutaneous coronary intervention (PCI) in elderly patients.Methods A total of 315 patients,aged 60-99 (72.89±7.80) years hospitalized during 2004 and 2015 due to coronary heart disease and received PCI therapy in the geriatric department of Peking University First Hospital were enrolled.Patients who received repeat revascularization were divided into the target lesion repeat revascularization (TLR)group and the non target lesion revascularization (non-TLR)group.Multivariate regression analysis was performed to make comparisons with non repeat revascularization group respectively and evaluate related risk factors.The median follow-up was 62months.Results The rate of TLR was less than non-TLR in elderly patients.Multivariate regression analysis showed that diabetes mellitus (HR 4.56,95％ CI 1.94-10.75,P＜0.05) and number of stents (HR 1.55,95％ CI 1.05-2.29,P＜0.05) were related risk factor of TLR,while age (HR 0.94,95％ CI 0.90-0.98,P＜0.05),the value of LDL-C reduction (HR 2.51,95％ CI 1.56-3.99,P＜0.05),the proportion of bifurcation lesions (HR 2.24,95％ CI 1.20-4.17,P＜0.05) and residual SYNTAX score (rSS) (HR 1.07,CI95％ 1.02-1.11,P＜0.05) wererelated risk factors of non-TLI.Conclusions The incidence of non-TLR were higher than TLR in elderly patients.Increased total number of stent implantation and diabetes mellitus were related risk factors of TLR,while the lower average age,less reduction of LDL-C,increased proportion of bifurcation lesions and higher rSS were related risk factors of non-TLR.