Effect And Safety Of Dual Antiplatelets With Aspirin And Clopidogrel After Percutaneous Coronary Intervention In Old Patients

BackgroundDual antiplatelets with aspirin and clopidogrel was one of the conventional therapies after percutaneous coronary intervention (PCI). However, the effect and safety of dual antiplatelets therapy in old patients, especially in those with acute coronary synderome (ACS), was not clarified yet.ObjectivesThis study was aimed to:1. Evaluate the effect and safety of dual antiplatelets therapy with aspirin and clopidogrel after PCI in different ages.2. Compare the effect and safety of dual antiplatelets therapy with aspirin and clopidogrel after PCI between the patients with ACS and those with stable angina.3. Explore the safety of dual antiplatelets therapy with aspirin and clopidogrel after PCI in very eldely patients with ACS. MethodsClinical data of 638 patients who underwent PCI and were followed up at least for 12 months from October,2003 to October,2007 in Liuhuaqiao Hospital were retrospectively collected and studied in the effects and safety of long-term dual antiplatelets therapy. After 27 patients were excluded because of incomplete data or failed to follow up,611 patients were enrolled in this study. Among the 611 patients, 488 cases were male,424 cases with ACS and 187 cases with stable angina pectoris. All of these patients were divided into different groups according to the different investigative objectives.1. Based on patients'age, the 611 PCI patients were divided into group A (age < 60 years. n=189), group B (age 60-69 years, n=151), group C (age 70-79 years, n=209) and group D (age≥80, n=62). The general data, cardiovascular risk factors, the number of implanted stents and with or without drug-eluting, rate of dual antiplatelets therapy (aspirin and clopidogrel) at 12 months after PCI, combined medicines, the major cardiovascular events, adverse events of antiplatelets therapy such as bleeding, thrombocytopenia and leukopenia were compared among 4 groups. The multiple-logistic regression analysis was employed to scan the related risk factors of cardiovascular events. The major cardiovascular events were defined as death, non-fatal myocardial infarction, non-fatal stroke and revasualization.2. All of the 422 old patients (aged at or over 60 years) were divided into ACS (n=273) and stable angina pectoris group (SAP, n=149) according to the initial diagnosis before PCI procedures. The general data, cardiovascular risk factors, interventional vessels and number of implanted stents, rate of dual antiplatelets therapy (aspirin and clopidogrel) at 12 months after PCI, combined medicines, the major cardiovascular events, adverse events of antiplatelets therapy such as bleeding, thrombocytopenia and leukopenia were compared among 2 groups. 3. Totally 416 ACS patients undergone PCI were retrospectively divided into group A (non-very eldely group, age< 70 year, n=246) and group B (very eldely group, age≥70year, n= 170). The usadge of aspirin and clopidogrel loading doses, duration as well as incidences of adverse events of anti-platelet therapy (included hemorrhagic events, thrombocytopenia and leukopenia) were compared between the two groups. The multiple-logistic regression analysis was employed to scan hemorrhagic events related risk factors.Results1.With the increase of age, ratios of male and smoker, body weight, incidences of ACS and hyperlipidemia were decreased while the incidences of diabetes mellitus and hypertension were increased. There were significant differences among groups (P＜0.05). The ratio of continuous use of clopidogrel for more than 12 months was increased while the age getting eld. There were no significant differences among groups in the rate of target vessel revascularation, bleeding, as well as thrombocytopenia and leukopenia (all P>0.05). Logistic regression analysis showed that age (aged more than 60 years), male, stents of left circumflex artery and diabetes mellitus-were independent risk factors of major cardiovascular events after PCI (OR were 2.04,1.88,1.76 and 2.17, respectively, all P<0.05).2. During one year follow-up, there were 59 cases of cardiac events in ACS group (12 case of cardiac death,9 cases of non-fatal myocardial infarctions,35 cases of revascularization and 3 cases of stroke), and 23 cases of cardiac events (8 case of cordial death,1 cases of myocardial infarction,12 cases of revascularization and 2 cases of stroke) in SAP group. There was no significant difference in the major cardiac events rate as well as the adverse events of anti-platelet therapy (hemorrhagic events, thrombocytopenia, leukopenia) between the two groups (P>0.05).3.For ACS patients, the loading doses and duration of aspirin and clopidogrel were not significantly different between group A and group B (P>0.05). The incidences of bleeding were 3.2% in group A and 4.0% in group B, respectively (P> 0.05). There were no significant differences in thrombocytopenia and leukopenia between two groups (P>0.05). Logistic regression analysis showed that Taking clopidogrel more than 12 months was an independent risk factor of hemorrhagic events (OR value was 5.40,95%CI:1.26-23.15, P＜0.05). The therapy with proton pump inhibitors (OR value was 0.18,95%CI:0.047-0.706,P=0.014) was the independent risk factors of reducing hemorrhagic events.Conclusions1. Cardiovascular risk factors were different in different aged population. For younger population, more attentions should be paid to body weight, blood lipids and smoking while controlling blood pressure and blood glucose were the main strategies for the eld population. Strictly control of hypertension and smoking might help to prevent the incidence of ACS.Z With increasing of the age, the incidence of major cardiovascular events after PCI procedure increased while adverse events rate of long-term dual antiplatelets therapy with aspirin and clopidogrel did not increase. The eldely patients (aged more than 60 years), male, stents of left circumflex artery and diabetes mellitus were the independent risk factors of major cardiovascular events after PCI.3. There was no significant difference in adverse events of anti-platelet therapy (hemorrhagic events, thrombocytopenia, leukopenia) between the patients with ACS and those with stable angina pectoris.4. There was no significant difference in adverse events of dual antiplatelets therapy with aspirin and clopidogrel after PCI between very eldely ACS patients (aged more than 70 years) and those younger ACS patients.5. Prolonged use of clopidogrel (more than 12 months) was the independent risk factor of hemorrhagic events. However, age was not the determiner to the safety of dual antiplatelets therapy.