Abstract 13198: Efficacy and Safety of Vorapaxar in Elderly Patients With Non-ST-Segment Elevation Acute Coronary Syndrome: Insights From the TRACER Trial
Background: Antithrombotic therapy plays an important role in the treatment of non-ST-segment elevation acute coronary syndromes (NSTE ACS), particularly in the elderly. Because age may be an important modifier of the relationship between antithrombotic agents, clinical efficacy, and risk of bleeding, we aimed to investigate the efficacy and safety of vorapaxar, a thrombin-receptor antagonist, according to age.
Methods: We studied 12,944 patients with NSTE ACS enrolled in the TRACER trial. Age was analyzed as a continuous variable and displayed as categorical (<75 and ≥75 years) for descriptive purposes. The primary efficacy endpoint of the trial was a composite of cardiovascular (CV) death, myocardial infarction (MI), stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization, and the key secondary endpoint was a composite of CV death, MI, or stroke. Logistic regression models were developed to adjust for important baseline characteristics.
Results: Of the overall population, 10,738 (83%) were aged <75 years and 2206 (17%) were aged ≥75 years. Older patients had higher rates of hypertension, previous stroke, and prior carotid stenosis ≥50% compared with patients aged <75 years. Elderly patients were at a higher risk of occurrence of the primary endpoint and the key secondary efficacy outcomes, as compared with younger patients (adjusted HR 1.40 [95% CI 1.23-1.60], p<0.001; adjusted HR 1.53 [95% CI 1.33-1.77], p<0.001; respectively). Similar excess risk was seen for bleeding (adjusted HR 1.54 [95% CI 1.36-1.75], p<0.001 for TIMI major or minor; adjusted HR 1.42 [95% CI 1.27-1.59], p<0.001 for GUSTO moderate or severe). There were no significant interactions between vorapaxar and age for the key clinical outcomes (Figure).
Conclusion: Increasing age was associated with greater risk for ischemic events and bleeding. The efficacy and safety of vorapaxar was not significantly influenced by age.
- © 2013 by American Heart Association, Inc.