Stefano Benenati, Felice Gragnano, Sebastiano Stratoti, Riccardo Scalamera, Vincenzo De Sio, Antonio Capolongo, Arturo Cesaro, Gianmarco Annibali, Salvatore Campagnuolo, Angelo Silverio, Michele Bellino, Matteo Schettino, Edoardo Bertero, Letizia Carelli, Giorgio Caretta, Marco Rezzaghi, Francesco Veneziano, Gennaro De Rosa, Mario Centore, Davide De Nardo, Rocco Vergallo, Leonardo De Luca, Gennaro Galasso, Alberto Menozzi, Giuseppe Musumeci, Plinio Cirillo, Paolo Calabrò, Italo Porto
In this real-world study of patients undergoing PCI with cangrelor, elderly individuals accounted for one-third of the population. Elderly patients were at higher risk of NACE, driven by both ischemic and bleeding events.
BACKGROUND/OBJECTIVES: We aimed to assess the clinical characteristics and in-hospital outcomes of elderly vs. nonelderly patients treated with cangrelor during percutaneous coronary intervention (PCI).
METHODS: Patients undergoing PCI with cangrelor between January 2019 and May 2023 in seven Italian institutions were retrospectively enrolled. Patients aged ≥75 years at the time of PCI were classified as elderly. The primary endpoint was net adverse clinical events (NACE), a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis, and Bleeding Academic Research Consortium (BARC) types 2, 3, or 5 bleeding, evaluated at 48 h post-PCI. The impact of advanced age (≥75 years) on clinical outcomes was assessed using multivariable logistic regression (LR), inverse probability of treatment weighting (IPTW), and doubly robust (DR) models.
RESULTS: A total of 1071 patients were included, of whom 340 (32%) were elderly. At 48 h, elderly patients had higher odds of NACE [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.12-3.97, P = 0.021 by multivariable LR; OR 1.98, 95% CI 1.45-2.27, P < 0.001 with IPTW; and OR 2.09, 95% CI 1.51-2.93, P < 0.001 by DR estimation]. These results were driven by an increased risk of both ischemic and bleeding events, the latter including access-site and nonaccess-site hemorrhages of both minor and major severity.
CONCLUSIONS: In this real-world study of patients undergoing PCI with cangrelor, elderly individuals accounted for one-third of the population. Elderly patients were at higher risk of NACE, driven by both ischemic and bleeding events.