Novel Antithrombotics in Geriatric PCI for STEMI: Balancing Ischemic Protection with Bleeding Risk
Keywords:
Older Adults, Geriatric, Percutaneous Coronary Intervention, ST-Segment elevation Myocardial InfarctionReferences
Kuna C, Bradaric C, Koch T, Presch A, Voll F, Kufner S, et al. Age-related ten-year outcomes after percutaneous coronary intervention of in-stent restenosis. Int J Cardiol. 2025;428:133109.
https://doi.org/10.1016/j.ijcard.2025.133109
PMid:40056938
Hanna JM, Wang SY, Kochar A, Park DY, Damluji AA, Henry GA, et al. Complex percutaneous coronary intervention outcomes in older adults. J Am Heart Assoc. 2023;12(19):e029057.
https://doi.org/10.1161/JAHA.122.029057
PMid:37776222 PMCid:PMC10727245
Arisha MJ, Ibrahim DA, Abouarab AA, Rahouma M, Kamel MK, Baudo M, et al. Percutaneous coronary intervention in the elderly: current updates and trends. Vessel Plus. 2018;2:14.
https://doi.org/10.20517/2574-1209.2018.29
Byrne RA, Rossello X, Coughlan J, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 12;44(38):3720-826.
Peiyuan H, Jingang Y, Haiyan X, Xiaojin G, Ying X, Yuan W, Wei L, Yang W, Xinran T, Ruohua Y, Chen J. The comparison of the outcomes between primary PCI, fibrinolysis, and NO reperfusion in patients≥ 75 years old with ST-segment elevation myocardial infarction: results from the Chinese acute myocardial infarction (CAMI) registry. PLoS One. 2016 Nov 3;11(11):e0165672.
https://doi.org/10.1371/journal.pone.0165672
PMid:27812152 PMCid:PMC5094717
Sui YG, Teng SY, Qian J, Wu Y, Dou KF, Tang YD, Qiao SB, Wu YJ. A retrospective study of an invasive versus conservative strategy in patients aged≥ 80 years with acute ST-segment elevation myocardial infarction. Journal of International Medical Research. 2019 Sep;47(9):4431-41.
https://doi.org/10.1177/0300060519860969
PMid:31347422 PMCid:PMC6753558
Fernández-Bergés D, Degano IR, Gonzalez Fernandez R, Subirana I, Vila J, Jiménez-Navarro M, Perez-Fernandez S, Roqué M, Bayes-Genis A, Fernandez-Aviles F, Mayorga A. Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction. Open Heart. 2020 Aug;7(2):e001169.
https://doi.org/10.1136/openhrt-2019-001169
PMid:32747454 PMCid:PMC7402007
Cequier Á, Ariza-Solé A, Elola FJ, Fernández-Pérez C, Bernal JL, Segura JV, Iñiguez A, Bertomeu V. Impact on mortality of different network systems in the treatment of ST-segment elevation acute myocardial infarction. The Spanish experience. Revista Española de Cardiología (English Edition). 2017 Mar 1;70(3):155-61.
https://doi.org/10.1016/j.rec.2016.07.005
PMid:27600863
Bainey KR, Armstrong PW, Zheng Y, Brass N, Tyrrell BD, Leung R, Westerhout CM, Welsh RC. Pharmacoinvasive strategy versus primary percutaneous coronary intervention in ST-elevation myocardial infarction in clinical practice: insights from the vital heart response registry. Circulation: Cardiovascular Interventions. 2019 Oct;12(10):e008059.
https://doi.org/10.1161/CIRCINTERVENTIONS.119.008059
PMid:31607152
Bainey KR, Welsh RC, Zheng Y, Arias-Mendoza A, Ristic A, Averkov OV, Lambert Y, Temple TC, Bogaerts K, Sinnaeve P, Westerhout CM. Pharmaco-invasive strategy with half-dose tenecteplase in STEMI patients: prespecified pooled analysis of patients≥ 75 years in STREAM-1 and 2. Journal of the American College of Cardiology. 2024 Apr 2;83(13_Supplement):870-.
https://doi.org/10.1016/S0735-1097(24)02860-2
Shavadia J, Welsh R, Gershlick A, Zheng Y, Huber K, Halvorsen S, Steg PG, Van de Werf F, Armstrong PW, STREAM Investigators. Relationship Between Arterial Access and Outcomes in ST‐Elevation Myocardial Infarction With a Pharmacoinvasive Versus Primary Percutaneous Coronary Intervention Strategy: Insights From the ST rategic Reperfusion Early After Myocardial Infarction (STREAM) Study. Journal of the American Heart Association. 2016 Jun 13;5(6):e003559.
https://doi.org/10.1161/JAHA.116.003559
PMid:28525886 PMCid:PMC4937283
Agrawal RS, Yusuf J, Mahajan B, Mehta V, Mandal S, Mukhopadhyay S. Effect of prasugrel versus ticagrelor on coronary microcirculation in patients undergoing pharmacoinvasive strategy-acute and short-term results. Coronary Artery Disease. 2023 Sep 1;34(6):381-8.
https://doi.org/10.1097/MCA.0000000000001265
PMid:37471285
Capranzano P, Angiolillo DJ. Tailoring P2Y12 inhibiting therapy in elderly patients with myocardial infarction undergoing primary percutaneous coronary intervention. Journal of the American Heart Association. 2019 Sep 17;8(18):e014000.
https://doi.org/10.1161/JAHA.119.014000
PMid:31538837 PMCid:PMC6818005
Montalto C, Morici N, Munafò AR, Mangieri A, Mandurino-Mirizzi A, D'Ascenzo F, Oreglia J, Latib A, Porto I, Colombo A, Savonitto S. Optimal P2Y12 inhibition in older adults with acute coronary syndromes: a network meta-analysis of randomized controlled trials. European Heart Journal-Cardiovascular Pharmacotherapy. 2022 Jan;8(1):20-7.
https://doi.org/10.1093/ehjcvp/pvaa101
PMid:32835355
Ibrahim M, Tariq S, Afridi MK, Zafar A, Khamisani FA, Aminpoor H, Arfin SW, Fonarow GC, Greene SJ, Musani MH, Waqas SA. Potent P2Y12 Inhibitor Monotherapy Versus Dual Antiplatelet Therapy After Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Systematic Review and Meta-Analysis. Clinical and Applied Thrombosis/Hemostasis. 2026 Feb;32:10760296261422490.
https://doi.org/10.1177/10760296261422490
PMid:41671172 PMCid:PMC12901862
Fujisaki T, Kuno T, Ando T, Briasoulis A, Takagi H, Bangalore S. Potent P2Y12 inhibitors versus Clopidogrel in elderly patients with acute coronary syndrome: Systematic review and meta-analysis. American Heart Journal. 2021 Jul 1;237:34-44.
https://doi.org/10.1016/j.ahj.2021.03.009
PMid:33737060
Qadeer A, Khawar M, Abdul Ghaffar QB, Jain S, Fouad M, Kanwal K, Muhammad A, Iqbal Ghuman S, Bintay Khalid M, Gohar N, Umer Ishaq M. Impact of P2Y₁₂ inhibitor pretreatment on clinical outcomes in ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: a retrospective cohort study. Catheterization and Cardiovascular Interventions. 2026 Mar;107(4):1100-11.
https://doi.org/10.1002/ccd.70449
PMid:41457947
D'Ascenzo F, Elia E, de Filippo O, Manai R, Breviario S, Bruno F, et al. Net clinical benefit of different strategies of dual antiplatelet therapy in elderly patients: Data from the PRAISE registry. Int J Cardiol. 2022;353:9-14.
https://doi.org/10.1016/j.ijcard.2022.01.019
PMid:35090983
Meng S, Guo L, Ye Z, Wang J, Ding H, Wu S, et al. Comparison of clinical outcomes between ticagrelor and clopidogrel in elderly patients undergoing percutaneous coronary intervention: A cohort study. Clin Interv Aging. 2022;17:331-41.
https://doi.org/10.2147/CIA.S355210
PMid:35400997 PMCid:PMC8986484
Saint Croix G, Lacy SC, Gazzhal A, Ibrahim M, Gjergjindreaj M, Perez J, et al. Dual antiplatelet therapy in patients aged 75 years and older with coronary artery disease: A meta-analysis and systematic review. J Interv Cardiol. 2022;2022:3111840. Zhao X, Zhang J, Guo J, Wang J, Pan Y, Zhao X, et al. Comparison of safety and efficacy between clopidogrel and ticagrelor in elderly patients with acute coronary syndrome: A systematic review and meta-analysis. Front Pharmacol. 2021;12:743259. Gupta R, Lin M, Mehta A, Aedma SK, Shah R, Ranchal P, Vyas AV, Singh S, Kluck B, Combs WG, Patel NC. Protease-activated receptor antagonist for reducing cardiovascular events-A review on Vorapaxar. Current Problems in Cardiology. 2023 Mar 1;48(3):101035.
https://doi.org/10.1016/j.cpcardiol.2021.101035
PMid:34718032
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Galen Medical Journal

This work is licensed under a Creative Commons Attribution 4.0 International License.





