Abstract
Byline: Waiel Abusnina, Creighton Univ, Omaha, NE; Ahmad Al-abdouh, Saint Agnes Hosp, Baltimore, MD; Anas Bizanti, Saint Agnes Hosp, Windsor Mill, MD; Gauravpal S Gill, Creighton Univ SOM, Omaha, NE; Abdelrazeg Abdelrazeg Houssien, Creighton Univ, Omaha, NE; Yazeid Alshebani; Arun K Kanmanthareddy, CHI Health Clinic Cardiology, Omaha, NE; Khagendra B Dahal, LSUHSC, Farmington, CT Introduction: Potent oral P2Y12 inhibitors (prasugrel or ticagrelor) are recommended in patients who present with acute coronary syndrome (ACS) compared to clopidogrel on the basis of landmark trials. However, there is no clear recommendation for such agents in elderly patients (>65 years) with ACS. Methods: We queried the electronic databases of PubMed, Cochrane Central Register of Clinical Trials, EMBASE and ClinicalTrial.gov since inception through February 25, 2021 for randomized studies evaluating potent oral P2Y12 inhibitors vs. clopidogrel in elderly patients who present with ACS. Hazard ratios (HR) with 95% confidence interval (CI) were computed and p<0.05 was considered statistically significant. Results: Eight randomized studies including a total of 10,081 patients were included in this analysis. At mean follow-up of 26 months, there was no significant difference between potent oral P2Y12 inhibitors and clopidogrel in terms of MACE [HR 0.97, 95% CI 0.82-1.15; P 0.73] (Figure), all-cause mortality [HR 0.91, 95% CI; 0.75-1.10: P 1.00], myocardial infarction [HR 0.95, 95% CI; 0.78-1.17: P 0.64], and stroke [HR 1.24, 95% CI; 0.82-1.86: P 0.31]. There was significant increase in major bleeding with potent oral P2Y12 inhibitors in elderly compared to clopidogrel [HR 1.32, 95% CI; 1.09-1.59: P 0.004](Figure) while the cardiovascular mortality was significantly decreased in the elderly treated with potent oral P2Y12 inhibitors compared to clopidogrel [HR 0.82, 95% CI; 0.68-0.98: P 0.03]. Conclusions: This meta-analysis suggests that using potent oral P2Y12 inhibitors in elderly patients with ACS is associated with a reduction in the risk of cardiovascular mortality with increased risk of bleeding compared to clopidogrel with no significant change in terms of MACE.