Why the study?
It is important to establish more effective and safer antiplatelet treatment strategies according to age, prompting an evaluation of dual-antiplatelet therapy safety and efficacy across different age groups.
Does personalized antiplatelet therapy based on platelet function testing reduce adverse clinical events compared to standard therapy in chronic coronary syndrome patients undergoing PCI across different age groups?
Does personalized antiplatelet therapy based on platelet function testing reduce adverse clinical events compared to standard therapy in chronic coronary syndrome patients undergoing PCI across different age groups?
Personalized antiplatelet therapy based on platelet function testing reduces ischemic events without increasing bleeding in CCS patients under 65 years undergoing PCI, but provides no significant benefit over standard therapy in those 65 or older.
Personalized antiplatelet therapy reduces ischemic events without excess bleeding in CCS patients <65 years post-PCI but offers no benefit in those ≥65; extends age-specific tailoring evidence from this RCT subanalysis.
It is particularly important to establish more effective and safer antiplatelet treatment strategies according to age. The present subanalysis of the PATH-PCI trial was to determine the safety and efficacy of any dual-antiplatelet therapy (DAPT) strategy in different age groups. We randomized 2285 chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI) into a standard group or a personalized group from December 2016 to February 2018. The personalized group received personalized antiplatelet therapy (PAT) based on a novel platelet function test (PFT). The standard group received standard antiplatelet therapy (SAT). Then, all patients were divided according to age (under the age of 65 years and aged 65 years or over) to investigate the association and interaction of age on clinical outcomes at 180 days. In the patients under the age of 65 years, the incidence of NACEs was decreased in the personalized group compared to the standard group (5.1% vs. 8.8%, HR: 0.603, 95% CI: 0.409–0.888, P = .010). The rates of MACCEs (3.3% vs. 7.7%, HR: 0.450, 95% CI: 0.285–0.712, P = .001), MACEs (2.2% vs. 5.4%, HR: 0.423, 95% CI: 0.243–0.738, P = .002) also decreased. We did not find a significant difference in bleeding between the groups. In the patients aged 65 years or over, no difference in the primary endpoint was found (4.9% vs. 4.2%, P = .702), and comparable rates of survival were observed with the two strategies (all Ps > 0.05). The present study shows that PAT according to PFT was comparable to SAT at the 180-day follow-up for both ischemic and bleeding endpoints in CCS patients aged 65 years or over who underwent PCI. In patients under the age of 65 years, PAT can reduce ischemic events but does not increase bleeding, and it is an effective and safe treatment strategy. It may be necessary for young CCS patients after PCI to undergo PAT early after PCI.
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Pan et al. (2023) studied this question.
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