Abstract 4586: Balancing Mortality Benefit vs. Bleeding Risk for Intensive Antiplatelet Therapy among Acute Coronary Syndrome Patients: Insights from the CRUSADE Registry
Background: Among PCI-treated ACS patients, the TRITON study identified 3 groups (age >=75 yrs, body weight <60 kg, prior stroke/transient ischemic attack [TIA]) for whom greater platelet inhibition was associated with significantly higher bleeding risk. The prevalence of these high-risk groups and their associated outcomes in routine clinical practice is unknown.
Methods: Using data from the CRUSADE registry, we examined 41,593 NSTEMI and 6216 STEMI patients treated with PCI from 2003–2006 to determine the prevalence of these high-risk groups and observed rates of inhospital mortality and non-CABG-related TIMI major bleeding among those with and without these features.
Results: Patients with age >=75 yrs, weight <60 kg, and prior stroke/TIA represent 23%, 7%, and 6% of the NSTEMI and 18%, 8%, and 4% of the STEMI populations, respectively. The proportion of patients with 1 or more of these high-risk features is higher in community practice (30.3% of NSTEMI, 24.3% of STEMI) than in TRITON (19.6%). These patients had higher observed bleeding rates but also higher inhospital mortality relative to those without these features (Figure⇓). Patients without high-risk features had low mortality, yet inhospital bleeding rates remained higher than reported in TRITON (1.5% in clopidogrel arm at 15 months).
Conclusions: In routine practice, approximately 1/4 of ACS patients have 1 or more of the high-risk features associated with increased bleeding risk. However, these patients also represent those at highest acute risk for mortality. Thus, defining the optimal target population, dose, and concomitant therapy for intensive antiplatelet therapy requires further investigation.