Bleeding in the Elderly: Risk Factors and Impact on Clinical Outcomes After an Acute Coronary Syndrome, a Sub-study of the Randomized ANTARCTIC Trial

Benoit Lattuca (1, 2, 3, 4) , Guillaume Cayla (1) , Johanne Silvain (5, 2, 4) , Thomas Cuisset (6, 7, 8) , Florence Leclercq (9) , Stephane Manzo-Silberman (10) , Christophe Saint-Etienne (11) , Nicolas Delarche (12) , Rami El Mahmoud (13) , Didier Carrié (14) , Géraud Souteyrand (15) , Mathieu Kerneis (2, 4) , Marie Hauguel-Moreau (2, 4) , Michel Zeitouni (2, 4) , Paul Guedeney (2, 4) , Abdourahmane Diallo (2, 10) , Jean-Philippe Collet (4) , Eric Vicaut (10) , Gilles Montalescot (4, 2) , Action Study Group

1 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
2 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
3 IMAGINE - Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts
4 Institut de cardiologie [CHU Pitié-Salpêtrière]
5 CHU Pitié-Salpêtrière [AP-HP]
6 TIMONE - Hôpital de la Timone [CHU - APHM]
7 NORT - Nutrition, obésité et risque thrombotique
8 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
9 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
10 Hôpital Lariboisière-Fernand-Widal [APHP]
11 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
12 Centre hospitalier de Pau
13 Hôpital Ambroise Paré [AP-HP]
14 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
15 CHU Gabriel Montpied [Clermont-Ferrand]

Background: Elderly patients are at high-risk of bleeding, but are under-represented in clinical trials. Objectives: The aims were to determine the incidence and the predictive factors of bleeding and to assess the impact of bleeding on further ischemic outcomes in elderly patients after acute coronary syndrome (ACS) treated with percutaneous coronary intervention. Methods: From the 877 patients aged ≥ 75 years included in the ANTARCTIC randomized trial, data on Bleeding Academic Research Consortium (BARC) bleeding complications and major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, myocardial infarction, and stroke, were collected over 1 year. Results: Clinically relevant bleeding events (BARC types 2, 3, or 5) were observed in 20.6% of patients (n = 181) at 1 year, of which, one third occurred in the first month. Anemia (adjusted hazard ratio [adj.HR] 3.98, 95% confidence interval [CI] 1.41-11.22; p = 0.009), severe chronic renal failure (adj.HR 1.83, 95% CI 1.12-2.98; p = 0.015), and femoral access (adj.HR 2.54, 95% CI 1.71-3.77; p < 0.001) were independently associated with clinically relevant bleeding events, while age > 85 years (adj.HR 2.22, 95% CI 1.14-4.30; p = 0.018) was independently associated with major bleeding events (BARC types 3 or 5). Patients with a clinically relevant bleeding event had a higher rate of MACE at 1 year (adj.HR 2.04, 95% CI 1.24-3.38; p = 0.005), with a particularly strong effect on stroke (adj.HR 5.55, 95% CI 2.04-15.06; p < 0.001). Conclusions: Clinically relevant bleeding events were observed in one out of five elderly patients undergoing stenting for an ACS and were strongly associated with further stroke occurrence. Rather than the antiplatelet therapy, comorbidities and an age > 85 years predicted bleeding outcomes in this elderly population. Clinical trial registration: Clinicaltrials.gov identifier: NCT01538446. https://www.clinicaltrials.gov .

Domaines: Cardiologie et système cardiovasculaire; Pharmacologie

Benoit Lattuca, Guillaume Cayla, Johanne Silvain, Thomas Cuisset, Florence Leclercq, et al.. Bleeding in the Elderly: Risk Factors and Impact on Clinical Outcomes After an Acute Coronary Syndrome, a Sub-study of the Randomized ANTARCTIC Trial. American Journal of Cardiovascular Drugs, 2021, 21 (6), pp.681-691. ⟨10.1007/s40256-021-00468-8⟩. ⟨hal-03633900⟩