Abstract 12777: More Bleeding but No Additional Efficacy with Increasing Age in High-risk ACS Patients Treated with Early vs. Delayed, Provisional Eptifibatide
Background: Eptifibatide is indicated for use in high-risk acute coronary syndrome (ACS) pts undergoing an early invasive strategy. Elderly ACS pts are at high risk for death and recurrent thrombotic events and death and might benefit, but little is known of the relationship between age, timing of initiation of eptifibatide, and efficacy and safety.
Methods: We used data from 9406 high-risk non-ST-segment elevation (NSTE) ACS pts randomized in EARLY ACS to early eptifibatide vs delayed provisional use at PCI, to assess the continuous relationship of age with efficacy and bleeding (TIMI major, GUSTO moderate/severe, and transfusion) outcomes. In multivariable models of baseline predictors of clinical events we also included age x treatment interaction terms to assess whether treatment effect varied by age after adjusting for confounders.
Results: Of 9406 EARLY ACS pts, 13.8% were <55 yrs (n=1310); 27.4%, 55–64 yrs (n=2599); 32.9%, 65–74 yrs (n=3120); and 25.0%, >=75 yrs (n=2377). Older patients had more cardiac risk factors and prior cardiac disease, higher acuity at presentation, and more ischemic and bleeding complications. After adjustment, there was no association of age group with treatment effect for the 96-hour efficacy composite or 30-day death or myocardial infarction (figure). Increasing age was associated with more TIMI major bleeding with early vs delayed provisional treatment (figure), but the interaction was not significant for GUSTO moderate/severe bleeding or transfusion.
Conclusions: Incremental bleeding risk with early vs delayed provisional eptifibatide is amplified in older patients (particularly in those >65 yrs) with similar effect on ischemic outcomes despite higher baseline risk in the elderly. Consistent with the results of the main EARLY ACS trial, our data do not support routine early use of eptifibatide in the elderly.
- © 2010 by American Heart Association, Inc.