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首页> 外文期刊>The American Journal of Cardiology >Comparison of Age ( = 75 Years) and Platelet Reactivity to the Risk of Thrombotic and Bleeding Events After Successful Percutaneous Coronary Intervention With Drug-Eluting Stents (from the ADAPT-DES Study)
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Comparison of Age ( = 75 Years) and Platelet Reactivity to the Risk of Thrombotic and Bleeding Events After Successful Percutaneous Coronary Intervention With Drug-Eluting Stents (from the ADAPT-DES Study)

机译：与药物洗脱支架成功经皮冠状动脉干预后的血栓形成和出血发生风险的血小板反应比较（来自Adap-DES研究）

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Elderly patients may have increased platelet reactivity and adverse events after percutaneous coronary intervention. Whether age is an independent predictor of worse outcomes after accounting for platelet reactivity is unknown. We sought to determine the relation between age and platelet reactivity on 2-year outcomes after percutaneous coronary intervention with drug-eluting stents (DES). ADAPT-DES was a prospective observational registry comprising 8,582 DES-treated patients. Patients were categorized with an age cutoff of 75 years. On-clopidogrel platelet reactivity was evaluated with VerifyNow P2Y12 testing. Multivariable Cox proportional hazards regression models were used to describe the relation between increasing age and 2-year clinical outcomes. Patients >= 75 old were more likely to be women and had more cardiovascular risk factors and more extensive coronary artery disease than younger patients. Residual platelet reactivity on-clopidogrel increased slightly with age (adjusted r = 0.05, p = 75 years was associated with greater all-cause mortality (adjusted HR 1.64, 95% CI 1.25 to 2.15, p <0.001), myocardial infarction (adjusted HR 1.33, 95% CI 1.01 to 1.74, p = 0.04) and clinically relevant bleeding (adjusted HR 1.33, 95% CI 1.10 to 1.61 p = 0.003). In contrast, the risk of stent thrombosis was independent of age (adjusted HR 0.83, 95% CI 0.46 to 1.52, and p = 0.55). Considered as a continuous variable, age was directly related to clinically relevant bleeding, cardiac and all-cause mortality, was inversely related to stent thrombosis, and was not related to myocardial infarction. There was no significant interaction between age and on-treatment platelet reactivity for the risk of 2-year clinical outcomes. In conclusion, increasing age had a stronger association with the risk of death and bleeding than of thrombotic events. Despite being associated with older age, higher residual platelet reactivity did not modify the adjusted relative risks of ischemic and bleeding events associated with age. (C) 2019 Elsevier Inc. All rights reserved.
机译：经皮冠状动脉干预后，老年患者可能会增加血小板反应性和不良事件。在考虑血小板反应性后，年龄是否是更糟糕的结果的独立预测因素是未知的。我们试图在用药支架经皮冠状动脉介入后2年后的年龄和血小板反应性之间的关系（DES）。 Adapt-des是一个潜在观察登记，包含8,582名DES治疗的患者。患者分为75岁的年龄截止值。用QuestiveNow P2Y12测试评价氯吡格雷血小板反应性。多变量的Cox比例危险回归模型用于描述增加年龄和2年临床结果之间的关系。患者> = 75岁的患者更有可能是女性，并且具有比较年轻患者更广泛的心血管危险因素和更广泛的冠状动脉疾病。残留的血小板反应性随着年龄的增长（调节r = 0.05，P = 75岁，与更大的全导致死亡率（调整的HR 1.64,95％CI 1.215，P <0.001），心肌梗塞（调整为HR） 1.33,95％CI 1.01至1.74，P = 0.04）和临床相关的出血（调节的HR 1.33,95％CI 1.10至1.61 p = 0.003）。相比之下，支架血栓形成的风险与年龄无关（调整后HR 0.83， 95％CI 0.46至1.52，P = 0.55）。被认为是连续变量，年龄与临床相关的出血，心脏和全导致死亡率直接相关，与支架血栓形成成反比，与心肌梗死无关。年龄与治疗血小板反应性没有显着的相互作用对于2年的临床结果的风险。总之，随着死亡和出血的风险而不是血栓形成事件的风险更强。尽管与年龄有关，更高的Residua. l血小板反应性没有修改与年龄相关的缺血性和出血事件的调整后的相对风险。 （c）2019 Elsevier Inc.保留所有权利。

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