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1 . 2021

Therapeutic effects of triple antiplatelet therapy in elderly female patients with diabetes and acute myocardial infarction

Abstract

Background. Dual antiplatelet therapy (DAPT) is the cornerstone treatment of acute myocardial infarction (AMI).

Objective. The present study aimed to investigate the efficacy and safety of triple antiplatelet therapy (TAPT) in elderly female patients with diabetes and ST segment elevation myocardial infarction (STEMI), who had undergone percutaneous coronary intervention (PCI).

Methods. We designed a randomized, single-blind study. Control group A (97 elderly male patients with diabetes and STEMI, whose CRUSADE scores were <30) received aspirin, ticagrelor, and tirofiban. A total of 162 elderly female patients with diabetes and STEMI were randomly divided into two groups according to CRUSADE score. Group B (69 patients with CRUSADE score >31) received aspirin and ticagrelor. Group C (93 patients with CRUSADE score <30) received aspirin, ticagrelor and tirofiban. P-values <0.05 were considered statistically significant.

Results. Compared to the findings in group A, post-PCI Thrombolysis in Myocardial Infarction (TIMI) grade 3 blood flow and TIMI myocardial perfusion grade 3 were significantly less prevalent in group B (p<0.05). When compared to groups A and C, the incidence of major adverse complications was significantly higher in group B (p<0.05).

Conclusion. TAPT could effectively reduce the incidence of major complications in elderly female patients with diabetes and STEMI. However, close attention should be paid to hemorrhage in patients receiving TAPT.

Keywords:platelet aggregation, stroke, woman, aging, diabetes mellitus, myocardial infarction, percutaneous coronary intervention/methods

Liu Y., Gao Y., Liu H., Chen Q., Ji J., Jia K. Therapeutic effects of triple antiplatelet therapy in elderly female patients with diabetes and acute myocardial infarction. Arq. Bras. Cardiol. 2021; 116 (2): 229–235. DOI: https://doi.org/10.36660/abc.20190442

References

1. Yoshikawa Y., Shiomi H., Watanabe H., Natsuaki M., Kondo H., Tamura T., et al. Application of DAPT score to predict ischaemic and bleeding events in patients who underwent drug-eluting stent implantation: a landmark analysis of large pooled cohort. Eur Heart J. 2017; 38 (suppl 1): 611–2.

2. Wallentin L., Becker R.C., Budaj A., Cannon C.P., Emanuelsson H., Held C., et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009; 361 (11): 1045–57.

3. Brener S.J., Mehran R., Dressler O., Cristea E., Stone G.W. Diabetes mellitus, myocardial reperfusion, and outcome in patients with acute ST-elevation myocardial infarction treated with primary angioplasty (from HORIZONS AMI). Am J Cardiol. 2012; 109 (8): 1111–6.

4. Farhan S., Höchtl T., Kautzky-Willer A., Wojta J., Huber K. Antithrombotic therapy in patients with coronary artery disease and with type 2 diabetes mellitus. Wien Med Wochenschr. 2010; 160 (1–2): 30–8.

5. Liu H.L., Liu Y., Hao Z.X., Geng G.Y., Zhang Z.F., Jing S.B., et al. Comparison of primary coronary percutaneous coronary intervention between diabetic men and women with acute myocardial infarction. Pak J Med Sci. 2015; 31 (2): 420–5.

6. Park K.H., Jeong M.H., Ahn Y., Ahn T.H., Seung K.B., Oh D.J., et al. Comparison of short-term clinical outcomes between ticagrelor versus clopidogrel in patients with acute myocardial infarction undergoing successful revascularization; from Korea Acute Myocardial Infarction Registry – National Institute of Health. Int J Cardiol. 2016; 215: 193–200.

7. Liu Y., Liu H., Hao Z., Geng G., Chen Q., Han W., et al. Efficacy and safety of different doses of tirofiban combined with ticagrelor on diabetic patients with AMI receiving in emergency percutaneous coronary intervention (PCI). Int J Clin Exp Med. 2015; 8 (7): 11 360–9.

8. Liu Y., Liu H.L., Hao Y., Hao Z., Geng G., Han W., et al. Short-term efficacy and safety of three different antiplatelet regimens in diabetic patients treated with primary percutaneous coronary intervention: a randomised study. Kardiol Pol. 2017; 75 (9): 850–8.

9. Liu Y., Liu H.L., Geng Y.G., Ba N., Jing S.B., Guo W., et al. Effect of intracoronary injection of tirofiban on acute myocardial infarction in elderly patients with diabetes mellitus. Chin. J. Geriatr. Heart Brain Vessel Dis. 2013; 15: 799–802.

10. Subherwal S., Bach R.G., Chen A.Y., Gage B.F., Rao S.V., Newby L.K., et al. Baseline risk of major bleeding in non-ST-segment··elevation myocardial infarction: the CRUSADE (Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation. 2009; 119 (14): 1873–82.

11. Wessler J.D., Stant J., Duru S., Rabbani L., Kirtane A.J. Updates to the ACCF/AHA and ESC STEMI and NSTEMI Guidelines: Putting Guidelines Into Clinical Practice. Am J Cardiol. 2015; 115 (5 suppl): 23A–8A.

12. America Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010; 33: 204–9.

13. Bekler A., Altun B., Gazi E., Temiz A., Barutçu A., Güngör Ö., et al. Comparison of the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with acute coronary syndrome. Anatol J Cardiol. 2014; 15 (10): 801–6.

14. Schwietz T., Spyridopoulos I., Pfeiffer S., Laskowski R., Palm S., de Rosa S., et al. Risk stratification following complex PCI: clinical versus anatomical risk stratification including «post PCI residual SYNTAX-score» as quantification of incomplete revascularization. J Interv Cardiol. 2013; 26 (1): 29–37.

15. Chen Q., Liu Y., Liu H.L. Effects of intracoronary tirofiban administration on diabetes mellitus complicated by acute myocardial infarction in female patients undergoing emergency percutaneous coronary intervention. Int J Clin Exp Med. 2016; 9: 11 966–73.

16. Roger V.L., Go A.S., Lloyd-Jones D.M., Benjamin E.J., Berry J.D., Borden W.B., et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2012 update: a report from the American Heart Association. Circulation. 2012;125 (1): e2–220.

17. D’Ascenzo F., Gonella A., Quadri G., Longo G., Biondi-Zoccai G., Moretti C., et al. Comparison of mortality rates in women versus men presenting with ST-segment elevation myocardial infarction. Am J Cardiol. 2011; 107 (5): 651–4.

18. Fath-Ordoubadi F., Barac Y., Danzi G.B., Kerner A., Nikolsky E., Halabi M., et al. Gender impact on prognosis of acute coronary syndrome patients treated with drug-eluting stents. Am J Cardiol. 2012; 110 (5): 636–42.

19. Sathyamurthy I., Jayanthi K. Dual antiplatelet therapy in acute coronary syndromes and coronary artery interventions. J Assoc Physicians India. 2014; 62 (7): 596–601.

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CHIEF EDITOR
CHIEF EDITOR
Andrey G. Obrezan
MD, Professor, Head of the Hospital Therapy Department of the Saint Petersburg State University, Chief Physician of SOGAZ MEDICINE Clinical Group, St. Petersburg, Russian Federation

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