Effectiveness and safety of antithrombotic strategies in elderly patients with acute myocardial infarction

Table 1 Baseline patients’ characteristics, n (%)

Parameters	All (n = 105)	Pathology		P value
		STEMI (n = 37)	NSTEMI (n = 68)
Age (yr)	83.9 ± 3.6	83.6 ± 3.9	84.0 ± 3.5	0.592
Males	55 (52.3)	16 (43.2)	39 (57.3)	0.239
BMI (kg/m2)	25.9 ± 5.4	25.7 ± 3.8	26 ± 6.1	0.787
LVEF (%)	45 ± 11.1	43 ± 12.2	46 ± 10.5	0.190
History of AF	15 (14.3)	5 (13.5)	10 (14.7)	0.900
Paroxysmal	7 (7.7)	3 (8.1)	4 (5.9)	-
Persistent/Permanent	8 (7.6)	2 (5.4)	6 (8.8)	-
New onset AF	10 (9.5)	3 (8.1)	7 (10.2)	0.999
Hypertension	75 (71.4)	23 (62.2)	52 (76.5)	0.186
Dyslipidemia	36 (34.3)	10 (27)	26 (38.2)	0.347
Diabetes	34 (32.4)	13 (35.1)	21 (30.9)	0.821
Overweight	20 (19)	5 (13.5)	15 (22.1)	0.421
Smoking active or previous	21 (20)	5 (13.5)	16 (23.5)	0.332
Family history of CAD	9 (8.6)	4 (10.8)	5 (7.4)	0.789
Creatinine at admission (mg/dL)	1.15 ± 0.4	1.0 ± 0.4	1.2 ± 0.5	0.039
Creatinine at discharge (mg/dL)	1.31 ± 0.6	1.3 ± 0.5	1.3 ± 0.7	0.999
Hemoglobin at admission (g/dL)	12.6 ± 2.1	13.2 ± 2.0	12.3 ± 2.1	0.035
Hemoglobin at discharge (g/dL)	12.3 ± 1.9	12.4 ± 1.7	12.2 ± 1.9	0.594

Continuous variables are presented as mean value SD or median value (IQR). STEMI: ST-elevation myocardial infarction; NSTEMI: Non-ST-elevation myocardial infarction; BMI: Body mass index; LVEF: Left ventricular ejection fraction; AF: Atrial fibrillation; CAD: Coronary artery disease.

Table 2 Acute management and antithrombotic therapy, n (%)

Treatment strategy	All (n = 105)	Pathology		P value
		STEMI (n = 37)	NSTEMI (n = 68)
Acute management
Coronary angiography	76 (72.4)	34 (91.9)	42 (61.8)	0.001
Coronary revascularization	60 (57.1)	34 (91.9)	26 (38.2)	< 0.001
Elective medical therapy	29 (27.6)	3 (8.1)	26 (38.2)	0.001
Antithrombotic therapy
SAPT	18 (17.1)	3 (8.1)	15 (22)	0.115
DAPT	66 (62.9)	28 (75.7)	38 (55.9)	0.072
SAPT + OAC	10 (9.5)	3 (8.1)	7 (10.3)	0.999
Triple therapy	11 (10.5)	3 (8.1)	8 (11.8)	0.823

STEMI: ST-elevation myocardial infarction; NSTEMI: Non-ST-elevation myocardial infarction; SAPT: Single antiplatelet therapy; DAPT: Double antiplatelet therapy; OAC: Oral anticoagulation.

Table 3 Clinical outcomes, n (%)

Clinical outcomes	All	Pathology		P value
		STEMI	NSTEMI
Efficacy endpoint
In-hospital mortality	6/105 (5.7)	3/37 (8.1)	3/68 (4.4)	0.702
1-year MACEs1	7/90 (7.8)	4/32 (12.5)	3/58 (5.2)	0.457
Ischemic stroke	1/90 (1.1)	0/32	1/58 (1.7)	-
Cardiovascular death	3/90 (3.3)	2/32 (6.3)	1/58 (1.7)	-
Myocardial infarction	3/90 (3.3)	2/32 (6.3)	1/58 (1.7)	-
1-year non-cardiovascular death	11/90 (12.2)	6/32 (18.8)	5/58 (8.6)	0.369
Safety endpoint
In-hospital minor bleeding	2/105 (1.9)	0/37	2/68 (2.9)	0.834
In-hospital major bleeding	1/105 (1.0)	0/37	1/68 (1.5)	0.999
Minor bleeding after discharge1	9/90 (10)	3/32 (9.4)	6/58 (10.3)	0.999
Major bleeding after discharge1	2/90 (2.2)	0/32	2/58 (3.4)	0.846

¹1-year MACE and after-discharge bleeding events percentages refer to 90 patients (9 patients were lost to follow-up and 6 patients died during hospitalization). STEMI: ST-elevation myocardial infarction; NSTEMI: Non-ST-elevation myocardial infarction; MACEs: Major adverse cardiovascular events.

Table 4 Comparison of observational studies including elderly patients with acute coronary syndrome

Ref.	Cohort	Mean age (yr)	Invasive strategy (%)	In-hospital mortality (%)	Major bleeding (%)	MACEs (%)
Rosengren et al[13], 2006	NSTE-ACS, STE-ACS	N/A; 25% of patients > 75 yr	34.6	4.7; 9.7 in patients 75 yr	N/A	N/A
Devlin et al[22], 2008	NSTE-ACS	66	38	5.8	2.4	9.2
Nagata et al[19], 2017	NSTE-ACS (Elderly group 80 yr)	73	79	8.5	0	9.9
Toleva et al[32], 2015	STE-ACS (Elderly group 75 yr)	82.2	70.1	14.2	13	27.6

NSTE-ACS: Non ST-elevation acute coronary syndrome; STE-ACS: ST-elevation acute coronary syndrome; MACEs: Major adverse cardiovascular events; N/A: Not available.