This study sought to evaluate the impact of age on outcomes in patients with moderate-
and high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) enrolled
in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.
Aging-associated changes in physiology and metabolism may alter the risk and benefit
of therapeutic strategies from that observed in younger people.
We performed a pre-specified analysis of 30-day and 1-year outcomes in 4 age groups,
overall and among those undergoing percutaneous coronary intervention (PCI).
Of 13,819 patients in the ACUITY trial, 3,655 (26.4%) were <55 years of age, 3,940
(28.5%) were 55 to 64 years of age, 3,783 (27.4%) were 65 to 74 years of age, and
2,441 (17.7%) were > or =75 years of age. Older patients had more cardiovascular risk
factors and had a higher acuity at presentation. Patients age > or =75 years treated
with bivalirudin alone had similar ischemic outcomes, but significantly lower rates
of bleeding compared with those treated with heparin and glycoprotein IIb/IIIa inhibitors
overall and in the PCI subset. The number needed to treat with bivalirudin alone to
avoid 1 major bleeding event was lower in this age group (23 overall and 16 for PCI-treated
patients) than in any other.
Ischemic and bleeding complications after NSTE-ACS increase with age. Although ischemic
event rates are not statistically different with either bivalirudin alone or a heparin
plus glycoprotein IIb/IIIa inhibitor, bleeding complications are significantly less
frequent with bivalirudin alone. Because of the substantial risk of bleeding in patients
age > or =75 years, the number needed to treat to avoid 1 major bleeding event using
bivalirudin alone was the lowest in the elderly group, especially among those undergoing
PCI.