Clinical characteristics, therapeutic strategies, and outcomes in elderly patients on oral anticoagulant therapy undergoing percutaneous coronary interventions: <i>post-hoc</i> analysis of the PERSEO Registry.

Simona MINARDI; Salvatore DE ROSA; Nicolò SALVI; Giuseppe ANDÒ; Giuseppe TALANAS; Claudio D'ANGELO; Carolina MORETTI; Tiziano Maria MAZZA; Bernardo CORTESE; Giuseppe MUSUMECI; Andrea RUBBOLI; Alessandro SCIAHBASI

Return

Clinical characteristics, therapeutic strategies, and outcomes in elderly patients on oral anticoagulant therapy undergoing percutaneous coronary interventions: post-hoc analysis of the PERSEO Registry.

Author: Simona MINARDI ¹ ; Salvatore DE ROSA ² ; Nicolò SALVI ³ ; Giuseppe ANDÒ ⁴ ; Giuseppe TALANAS ⁵ ; Claudio D'ANGELO ⁴ ; Carolina MORETTI ⁶ ; Tiziano Maria MAZZA ³ ; Bernardo CORTESE ⁷ ; Giuseppe MUSUMECI ⁸ ; Andrea RUBBOLI ⁶ ; Alessandro SCIAHBASI ³
Author Information

1. Division of Cardiology, Sant'Eugenio Hospital, Rome, Italy.
2. Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
3. Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy.
4. Department of Clinical and Experimental Medicine, Cardiology Section, University of Messina, Messina, Italy.
5. Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.
6. Department of Emergency, Internal Medicine and Cardiology, Division of Cardiology, S. Maria delle Croci Hospital, Ravenna, Italy.
7. University Hospitals Harrington Heart & Vascular Institute, Cleveland, USA.
8. Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy.
Publication Type:Journal Article
From: Journal of Geriatric Cardiology 2025;22(8):701-708
CountryChina
Language:English
Abstract: BACKGROUND:Antithrombotic strategies after percutaneous coronary interventions (PCI) in elderly patients on oral anticoagulant therapy (OAT) are debated due to the balance between ischemic and bleeding risks. Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy, but there are limited data on elderly patients.
METHODS:We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features, therapeutic strategies, and outcomes of individuals aged ≥ 80 years and < 80 years who were on OAT and underwent PCI with stent. The primary endpoint was net adverse clinical events at 1-year follow-up. Secondary endpoints included major adverse cardiac and cerebral events (MACCE), major bleeding [Bleeding Academic Research Consortium (BARC) type 3-5], and clinically relevant bleeding (BARC type 2-5).
RESULTS:Among the 1234 patients enrolled, 31% of patients were aged ≥ 80 years (84 ± 3 years, 76% males). Compared to younger patients, elderly patients had higher rates of comorbidities such as hypertension, anaemia or chronic kidney disease, and atrial fibrillation was the leading indication for OAT. Elderly patients were more often discharged on dual antithrombotic therapy (23%) compared to younger patients (13%) (P < 0.0001). They experienced higher net adverse clinical events (38% vs. 21%, P < 0.001), MACCE (24% vs. 12%, P < 0.001), as well as higher bleeding rates. Specifically, rates of major bleeding (9% vs. 6%, P = 0.026), and clinically relevant bleeding (21% vs. 12%, P < 0.001) were significantly higher in elderly patients.
CONCLUSIONS:Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.