Background:Elderly patients with acute myocardial infarction undergoing percutaneous coronary intervention are at increased risk of both ischemic and bleeding complications. The optimal anticoagulation strategy in these patients is uncertain. Therefore, we compared bivalirudin to heparin monotherapy in a contemporary cohort of such patients.Methods:A prespecified subgroup analysis of elderly patients with myocardial infarction (≥75 years) from the VALIDATE-SWEDEHEART trial (Bivalirudin Versus Heparin in ST-Segment and Non–ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial) was performed. In the trial, patients were randomized to either bivalirudin or heparin monotherapy during percutaneous coronary intervention, with mandatory potent P2Y12 inhibition, routine radial artery access, and only bail-out glycoprotein IIb/IIIa inhibition. Kaplan-Meier event rates were assessed for the primary end point, consisting of a composite of all-cause death, myocardial reinfarction, or major bleeding, within 180 days.Results:The elderly (n=1592) had more than twice the risk of all events compared with younger patients (n=4406). Baseline and periprocedural characteristics were equal between bivalirudin (n=799) and heparin (n=793) treated patients ≥75 years. No differences were found in the elderly between bivalirudin and heparin monotherapy regarding the primary end point (180-day all-cause death, myocardial reinfarction, or major bleeding), the individual components of the primary end point, definite stent thrombosis, or stroke.Conclusions:In this prespecified subgroup analysis of the VALIDATE-SWEDEHEART trial, elderly patients with myocardial infarction had a highly increased risk of all events. However, no difference in outcomes could be observed with an anticoagulation strategy with either bivalirudin or heparin as monotherapy in this patient group.

中文翻译：

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比伐卢定与肝素单药治疗老年心肌梗死

背景：老年急性心肌梗死患者经皮冠状动脉介入治疗的缺血性和出血性并发症的风险增加。这些患者的最佳抗凝策略尚不确定。因此，我们在当代此类患者队列中将比伐卢定与肝素单药进行了比较。方法：VALIDATE-SWEDEHEART试验（比伐卢定与肝素在ST段和非-在瑞典网络系统中对现代抗血小板治疗的患者进行ST段抬高型心肌梗死，以根据推荐的治疗方法注册试验评估对心脏病的循证护理的增强和发展。在审判中 患者在经皮冠状动脉介入治疗期间被随机分为比伐卢定或肝素单药治疗，具有强制性强效P2Y12抑制，常规radial动脉进入和仅纾缓糖蛋白IIb / IIIa抑制的作用。在180天内评估了主要终点的Kaplan-Meier事件发生率，包括所有原因导致的死亡，心肌再梗塞或大出血的综合结果。结果：n = 1592的老年人患病的风险是其两倍以上所有事件均与年轻患者相比（n = 4406）。比伐卢定（n = 799）和肝素（n = 793）治疗的≥75岁患者的基线和围手术期特征相同。老年人在比伐卢定和肝素单药治疗的主要终点（180天全因死亡，心肌梗塞或大出血）方面无差异，结论：在VALIDATE-SWEDEHEART试验的这一预先确定的亚组分析中，老年心肌梗塞患者发生所有事件的风险大大增加。但是，在该患者组中，使用比伐卢定或肝素作为单一疗法的抗凝策略未观察到预后的差异。