Abciximab in elderly with Acute Coronary Syndrome invasively treated: Effect on outcome
Introduction
Elderly are increasingly represented among patients with Acute Coronary Syndromes (ACS), and advanced age has been identified as an important risk factor for death and adverse outcome in patients with ACS invasively treated [1]. Although several data have demonstrated the prognostic benefit of early revascularization in ACS particularly in high risk patients, [2], [3], [4] elderly with ACS are less treated with invasive procedures than younger patients [5], [6]. Besides, tough intravenous administration of platelet glycoprotein (GP) IIb/IIIa receptor antagonists has been showed effective in reducing ischemic complications in patients presenting with ACS and also during percutaneous coronary intervention (PCI) [2], [6], elderly patients are less often treated with these agents [7], [8], [9]. Moreover administrations of GPIIb/IIIa inhibitors (GPI) in these patients are still controversial since elderly have traditionally been underrepresented in clinical trial of ACS [10]. Consistently with lack of available study and current uncertainties regarding use of GPIIb/IIIa inhibitors in elderly, we analyzed clinical outcome in a consecutive series of elderly patients with Non-ST-elevation ACS who underwent coronary stenting with or without use of the GPIIb/IIIa receptor antagonists abciximab.
Section snippets
Study population
All patients aged ≥ 75 years with Non-ST-ACS [11] undergoing PCI at Federico II University of Naples from January 2001 to December 2003 were included in the study and stratified according to the use of abciximab, a potent GPIIb/IIIa inhibitor [12], [13], [14], [15].
PCI procedure, clinical and angiographic data analysis
PCI was performed according to the AHA/ACC guidelines, [16] through femoral approach using small size arterial sheaths (6F). Informed consent was obtained from each patient (or from their relatives in case of patient's inability)
Baseline characteristics
Between January 2001 and December 2003, 540 patients aged ≥ 75 years underwent PCI at Federico II University for Non-ST-ACS. Of these 247 patients (46%) received abciximab at the operator's discretion. Thus, according with GPIIb/IIIa inhibitor administration, we divided the study population into: GPI group (247 pts; mean age 77 ± 1.9 years; 71.8% male) treated by stenting plus abciximab and, no GPI (253 pts; mean age 77 ± 2.4 years; 76.9% male) treated by stenting alone. Baseline clinical
Discussion
Our results suggest that association of abciximab to stenting in elderly patients with Non-ST elevation ACS improves outcome by reducing MACE with a slight increase of bleedings.
Advanced age has been associated with an adverse outcome after an episode of Non-ST-elevation Acute Coronary Syndrome [1], [23], [24] and elderly patients represent a high risk population for coronary revascularization, being advanced age an independent predictor of overall mortality often associated with more diffuse
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