Advertisement

Impact of hemoglobin levels at admission on outcomes among elderly patients with acute coronary syndrome treated with low-dose Prasugrel or clopidogrel: A sub-study of the ELDERLY ACS 2 trial

      Highlights

      • Hemoglobin (Hb) levels could predict outcome in acute coronary syndromes (ACS).
      • Higher predictive value could be expected among elderly patients, displaying higher haemorragic risk.
      • We present a pre-specified subanalysis of the ELDELY-2 trial according to Hb quartiles at admission.
      • A significantly higher cardiovascular mortality was observed in patients with lower Hb.
      • Hb levels did not independently predict outcomes, after correction for baseline risk profile.

      Abstract

      Hemoglobin (Hb) levels have emerged as a useful tool for risk stratification and the prediction of outcome after myocardial infarction. We aimed at evaluating the prognostic impact of this parameter among patients in advanced age, where the larger prevalence of anemia and the higher rate of comorbidities could directly impact on the cardiovascular risk.

      Methods

      All the patients in the ELDERLY-2 trial, were included in this analysis and stratified according to the values of hemoglobin at admission. The primary endpoint of this study was cardiovascular mortality within one year. The secondary endpoints were all-cause mortality, MI, Bleeding Academic Research Consortium (BARC) type 2–3 or 5 bleeding, any stroke, re-hospitalization for cardiovascular event or stent thrombosis (probable or definite) within 12 months after index admission.

      Results

      We included in our analysis 1364 patients, divided in quartiles of Hb values (<12.2; 12.2–13.39; 13.44–14.49; ≥ 4.5 g/dl). At a mean follow- up of 330.4 ± 99.9 days cardiovascular mortality was increased in patients with lower Hb (HR[95%CI] = 0.76 [0.59–0.97], p = 0.03). Results were no more significant after correction for baseline differences (adjusted HR[95%CI] = 1.22 [0.41–3.6], p = 0.16). Similar results were observed for overall mortality. At subgroup analysis, (according to Hb median values) a significant interaction was observed only with the type of antiplatelet therapy, but not with major high-risk subsets of patients.

      Conclusions

      Among elderly patients with acute coronary syndrome managed invasively, lower hemoglobin at admission is associated with higher cardiovascular and all-cause mortality and major ischemic events, mainly explained by the higher risk profile.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bhatt D.L.
        • Lopes R.D.
        • Harrington R.A.
        Diagnosis and treatment of acute coronary syndromes: a review.
        JAMA. 2022 Feb 15; 327: 662-675
        • De Luca G.
        • Navarese E.P.
        • Suryapranata H.
        A meta-analytic overview of thrombectomy during primary angioplasty.
        Int. J. Cardiol. 2013; 166: 606-612
        • De Luca G.
        • Smits P.
        • Hofma S.H.
        • Di Lorenzo E.
        • Vlachojannis G.J.
        • Van’t Hof A.W.J.
        • van Boven A.J.
        • Kedhi E.
        • Stone G.W.
        • Suryapranata H.
        Drug-eluting stent in primary angioplasty (DESERT 3) cooperation. Everolimus eluting stent vs first generation drug-eluting stent in primary angioplasty: a pooled patient-level meta-analysis of randomized trials.
        Int. J. Cardiol. 2017; 244: 121-127
        • De Luca G.
        • Dirksen M.T.
        • Spaulding C.
        • Kelbæk H.
        • Schalij M.
        • Thuesen L.
        • van der Hoeven B.
        • Vink M.A.
        • Kaiser C.
        • Musto C.
        • Chechi T.
        • Spaziani G.
        • Diaz de la Llera L.S.
        • Pasceri V.
        • Di Lorenzo E.
        • Violini R.
        • Suryapranata H.
        • Stone G.W.
        DESERT cooperation. Time course, predictors and clinical implications of stent thrombosis following primary angioplasty. Insights from the DESERT cooperation.
        Thromb. Haemost. 2013; 110: 826-833
        • Pancholy S.B.
        • Shantha G.P.
        • Patel T.
        • Cheskin L.J.
        Sex differences in short-term and long-term all-cause mortality among patients with ST-segment elevation myocardial infarction treated by primary percutaneous intervention: a meta-analysis.
        JAMA Intern. Med. 2014; 174: 1822-1830
        • De Luca G.
        • Dirksen M.T.
        • Spaulding C.
        • Kelbæk H.
        • Schalij M.
        • Thuesen L.
        • van der Hoeven B.
        • Vink M.A.
        • Kaiser C.
        • Musto C.
        • Chechi T.
        • Spaziani G.
        • Diaz de la Llera L.S.
        • Pasceri V.
        • Di Lorenzo E.
        • Violini R.
        • Suryapranata H.
        • Stone G.W.
        DESERT Cooperation. Meta-analysis comparing efficacy and safety of first generation drug-eluting stents to bare-metal stents in patients with diabetes mellitus undergoing primary percutaneous coronary intervention.
        Am. J. Cardiol. 2013; 111: 1295-1304
        • Piccolo R.
        • Franzone A.
        • Koskinas K.C.
        • Räber L.
        • Pilgrim T.
        • Valgimigli M.
        • Stortecky S.
        • Rat-Wirtzler J.
        • Silber S.
        • Serruys P.W.
        • Jüni P.
        • Heg D.
        • Windecker S.
        Effects of diabetes mellitus on frequency of adverse events in patients with acute coronary syndromes undergoing percutaneous coronary intervention.
        Am. J. Cardiol. 2016 Aug 1; 118: 345-352
        • Donahoe S.M.
        • Stewart G.C.
        • McCabe C.H.
        • Mohanavelu S.
        • Murphy S.A.
        • Cannon C.P.
        • Antman E.M.
        Diabetes and mortality following acute coronary syndromes.
        JAMA. 2007; 298: 765-775
        • De Luca L.
        • Marini M.
        • Gonzini L.
        • Boccanelli A.
        • Casella G.
        • Chiarella F.
        • De Servi S.
        • Di Chiara A.
        • Di Pasquale G.
        • Olivari Z.
        • Caretta G.
        • Lenatti L.
        • Gulizia M.M.
        • Savonitto S.
        • l.
        Contemporary trends and age-specific sex differences in management and outcome for patients with ST-segment elevation myocardial infarction.
        J. Am. Heart Assoc. 2016; (epub Nov 23)https://doi.org/10.1161/JAHA.116.004202
        • Morici N.
        • De Servi S.
        • De Luca L.
        • Crimi G.
        • Montalto C.
        • De Rosa R.
        • De Luca G.
        • Rubboli A.
        • Valgimigli M.
        Savonitto S management of acute coronary syndromes in older adults.
        Eur. Heart J. 2022 Apr 19; 43: 1542-1553
        • Verdoia M.
        • Pergolini P.
        • Rolla R.
        • Nardin M.
        • Schaffer A.
        • Barbieri L.
        • Marino P.
        • Bellomo G.
        • Suryapranata H.
        • De Luca G.
        Advanced age and high-residual platelet reactivity in patients receiving dual antiplatelet therapy with clopidogrel or ticagrelor.
        J. Thromb. Haemost. 2016 Jan; 14: 57-64
        • Wiviott S.D.
        • Braunwald E.
        • McCabe C.H.
        • et al.
        TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes.
        N. Engl. J. Med. 2007; 357: 2001-2015
        • Roe M.T.
        • Goodman S.G.
        • Ohman E.M.
        • Stevens S.R.
        • Hochman J.S.
        • Gottlieb S.
        • Martinez F.
        • Dalby A.J.
        • Boden W.E.
        • White H.D.
        • Prabhakaran D.
        • Winters K.J.
        • Aylward P.E.
        • Bassand J.P.
        • McGuire D.K.
        • Ardissino D.
        • Fox K.A.
        • Armstrong P.W.
        Elderly patients with acute coronary syndromes managed without revascularization: insights into the safety of long-term dual antiplatelet therapy with reduced-dose prasugrel versus standard-dose clopidogrel.
        Circulation. 2013; 128: 823-833
        • Ohana-Sarna-Cahan L.
        • Atar S.
        Clinical outcomes of patients with acute coronary syndrome and moderate or severe chronic anaemia undergoing coronary angiography or intervention.
        Eur. Heart J. Acute Cardiovasc. Care. 2017 May; 1 (2048872617707959. (Epub ahead of print))https://doi.org/10.1177/2048872617707959
        • Brener S.J.
        • Mehran R.
        • Dangas G.D.
        • Ohman E.M.
        • Witzenbichler B.
        • Zhang Y.
        • Parvataneni R.
        • Stone G.W.
        Relation of baseline hemoglobin levels and adverse events in patients with acute coronary syndromes (from the acute catheterization and urgent intervention triage strategY and harmonizing outcomes with RevasculariZatiON and stents in acute myocardial infarction trials).
        Am. J. Cardiol. 2017 Jun 1; 119: 1710-1716
        • Yazji K.
        • Abdul F.
        • Elangovan S.
        • Ul Haq M.Z.
        • Ossei-Gerning N.
        • Morris K.
        • Anderson R.
        • Kinnaird T.
        Baseline anemia in patients undergoing percutaneous coronary intervention after an acute coronary syndrome-a paradox of high bleeding risk, high ischemic risk, and complex coronary disease.
        J. Interv. Cardiol. 2017; 30 (491–49)
        • Afilalo J.
        • Alexander K.P.
        • Mack M.J.
        • Maurer M.S.
        • Green P.
        • Allen L.A.
        • Popma J.J.
        • Ferrucci L.
        • Forman D.E.
        Frailty assessment in the cardiovascular care of older adults.
        J. Am. Coll. Cardiol. 2014; 63: 747-762
        • McKechnie R.S.
        • Smith D.
        • Montoye C.
        • et al.
        Blue cross blue shield of Michigan cardiovascular consortium (BMC2). Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention.
        Circulation. 2004; 110: 271-277
        • Ferri L.A.
        • Morici N.
        • Grosseto D.
        • Tortorella G.
        • Bossi I.
        • Sganzerla P.
        • Cacucci M.
        • Sibilio G.
        • Tondi S.
        • Toso A.
        • Ferrario M.
        • Gandolfo N.
        • Ravera A.
        • Mariani M.
        • Corrada E.
        • Di Ascenzo L.
        • Petronio A.S.
        • Cavallini C.
        • Moffa N.
        • De Servi S.
        • Savonitto S.
        A comparison of reduced-dose prasugrel and standard-dose clopidogrel in elderly patients with acute coronary syndromes undergoing early percutaneous revascularization: design and rationale of the randomized elderly-ACS 2 study.
        Am. Heart J. 2016 Nov; 181: 101-106
        • Mehran R.
        • Rao S.V.
        • Bhatt D.L.
        • et al.
        Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium.
        Circulation. 2011; 123: 2736-2747
        • Cutlip D.E.
        • Windecker S.
        • Mehran R.
        • et al.
        Academic research consortium. Clinical end points in coronary stent trials: a case for standardized definitions.
        Circulation. 2007; 115: 2344-2351
        • Kunadian V.
        • Mehran R.
        • Lincoff A.M.
        • et al.
        Effect of anemia on frequency of short- and long-term clinical events in acute coronary syndromes (from the acute catheterization and urgent intervention triage strategy trial).
        Am. J. Cardiol. 2014; 114: 1823-1829
        • Mehran R.
        • Pocock S.J.
        • Nikolsky E.
        • Clayton T.
        • Dangas G.D.
        • Kirtane A.J.
        • Parise H.
        • Fahy M.
        • Manoukian S.V.
        • Feit F.
        • Ohman M.E.
        • Witzenbichler B.
        • Guagliumi G.
        • Lansky A.J.
        • Stone G.W.
        A risk score to predict bleeding in patients with acute coronary syndromes.
        J. Am. Coll. Cardiol. 2010; 55 (2556e2566)
        • Tsujita K.
        • Nikolsky E.
        • Lansky A.J.
        • Dangas G.
        • Fahy M.
        • Brodie B.R.
        • Dudek D.
        • Möckel M.
        • Ochala A.
        • Mehran R.
        • Stone G.W.
        Impact of anemia on clinical outcomes of patients with ST-segment elevation myocardial infarction in relation to gender and adjunctive antithrombotic therapy (from the HORIZONS-AMI trial).
        Am. J. Cardiol. 2010; 105: 1385-1394
        • Nordstrom B.L.
        • Simeone J.C.
        • Zhao Z.
        • Molife C.
        • McCollam P.L.
        • Ye X.
        • Effron M.B.
        Adherence and persistence with prasugrel following acute coronary syndrome with percutaneous coronary intervention.
        Am. J. Cardiovasc. Drugs. 2013; 13: 263-271
        • Mamas M.A.
        • Kwok C.S.
        • Kontopantelis E.
        • Fryer A.A.
        • Buchan I.
        • Bachmann M.O.
        • Zaman M.J.
        • Myint P.K.
        Relationship between anemia and mortality outcomes in a National Acute Coronary Syndrome Cohort: insights from the UK myocardial ischemia National Audit Project Registry.
        J. Am. Heart Assoc. 2016; 5
        • Baber U.
        • Mehran R.
        • Giustino G.
        • Cohen D.J.
        • Henry T.D.
        • Sartori S.
        • Ariti C.
        • Litherland C.
        • Dangas G.
        • Gibson C.M.
        • Krucoff M.W.
        • Moliterno D.J.
        • Kirtane A.J.
        • Stone G.W.
        • Colombo A.
        • Chieffo A.
        • Kini A.S.
        • Witzenbichler B.
        • Weisz G.
        • Steg P.G.
        • Pocock S.
        Coronary thrombosis and major bleeding after PCI with drug-eluting stents: risk scores from PARIS.
        J. Am. Coll. Cardiol. 2016; 67: 2224-2234
        • Patti G.
        • Cavallari I.
        • Antonucci E.
        • Calabrò P.
        • Cirillo P.
        • Gresele P.
        • Palareti G.
        • Pengo V.
        • Pignatelli P.
        • Ricottini E.
        • Marcucci R.
        Prevalence and predictors of dual antiplatelet therapy prolongation beyond one year in patients with acute coronary syndrome.
        PLoS One. 2017; 12e0186961
        • Yazji K.
        • Abdul F.
        • Elangovan S.
        • et al.
        Comparison of the effects of incomplete revascularization on 12-month mortality in patients <80 compared with ≥80 years who underwent percutaneous coronary intervention.
        Am. J. Cardiol. 2016; 118: 1164-1170
        • Sudarsky D.
        • Sudarsky M.
        • Matezky S.
        • Goldenberg I.
        • Farcas A.
        • Nikolsky E.
        • Investigators A.C.S.I.S.
        Impact of early invasive approach on outcomes of patients with acute coronary syndrome and baseline anemia: analysis from the ACSIS registry.
        J. Interv. Cardiol. 2015; 28: 315-325
        • Wadowski P.P.
        • Kopp C.W.
        • Koppensteiner R.
        • Lang I.M.
        • Pultar J.
        • Lee S.
        • Weikert C.
        • Panzer S.
        • Gremmel T.
        Decreased platelet inhibition by P2Y12 receptor blockers in anaemia.
        Eur. J. Clin. Investig. 2018 Jan; 48
        • Al Falluji N.
        • Lawrence-Nelson J.
        • Kostis J.B.
        • Lacy C.R.
        • Ranjan R.
        • Wilson A.C.
        Myocardial infarction data acquisition system (MIDAS #8) study group. Effect of anemia on 1-year mortality in patients with acute myocardial infarction.
        Am. Heart J. 2002; 144: 636-641
        • De Luca G.
        • Secco G.G.
        • Cassetti E.
        • Verdoia M.
        • Bellomo G.
        • Marino P.
        Novara atherosclerosis study group (NAS). Haemoglobin levels do not correlate with the extent of coronary artery disease: results from a large cohort study.
        Coron. Artery Dis. 2014; 25: 463-468
        • Savonitto S.
        • Cavallini C.
        • Petronio A.S.
        • et al.
        For the Italian elderly ACS trial investigators. Early aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndrome: a randomized controlled trial.
        JACC Cardiovasc. Interv. 2012; 5: 906-916
        • Tegn N.
        • Abdelnoor M.
        • Aaberge L.
        • et al.
        After eighty study investigators. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (after eighty study): an open-label randomised controlled trial.
        Lancet. 2016; 387: 1057-1065
        • Savonitto S.
        • Ferri L.A.
        • Piatti L.
        • Grosseto D.
        • Piovaccari G.
        • Morici N.
        • Bossi I.
        • Sganzerla P.
        • Tortorella G.
        • Cacucci M.
        • Ferrario M.
        • Murena E.
        • Sibilio G.
        • Tondi S.
        • Toso A.
        • Bongioanni S.
        • Ravera A.
        • Corrada E.
        • Mariani M.
        • Di Ascenzo L.
        • Petronio A.S.
        • Cavallini C.
        • Vitrella G.
        • Rogacka R.
        • Antonicelli R.
        • Cesana B.M.
        • De Luca L.
        • Ottani F.
        • De Luca G.
        • Piscione F.
        • Moffa N.
        • De Servi S.
        Elderly ACS 2 Investigators. Comparison of reduced-dose prasugrel and standard-dose clopidogrel in elderly patients with acute coronary syndromes undergoing early percutaneous revascularization.
        Circulation. 2018; 137: 2435-2445
        • Kandzari D.E.
        • Kirtane A.J.
        • Windecker S.
        • Latib A.
        • Kedhi E.
        • Mehran R.
        • Price M.J.
        • Abizaid A.
        • Simon D.I.
        • Worthley S.G.
        • Zaman A.
        • Choi J.W.
        • Caputo R.
        • Kanitkar M.
        • McLaurin B.
        • Potluri S.
        • Smith T.
        • Spriggs D.
        • Tolleson T.
        • Nazif T.
        • Parke M.
        • Lee L.C.
        • Lung T.H.
        • Stone G.W.
        • Onyx ONE US/Japan Investigators
        One-month dual antiplatelet therapy following percutaneous coronary intervention with zotarolimus-eluting stents in high-bleeding-risk patients.
        Circ. Cardiovasc. Interv. 2020 Nov; 13 (e009565)https://doi.org/10.1161/CIRCINTERVENTIONS.120.009565
        • Valgimigli M.
        • Frigoli E.
        • Heg D.
        • Tijssen J.
        • Jüni P.
        • Vranckx P.
        • Ozaki Y.
        • Morice M.C.
        • Chevalier B.
        • Onuma Y.
        • Windecker S.
        • Tonino P.A.L.
        • Roffi M.
        • Lesiak M.
        • Mahfoud F.
        • Bartunek J.
        • Hildick-Smith D.
        • Colombo A.
        • Stanković G.
        • Iñiguez A.
        • Schultz C.
        • Kornowski R.
        • Ong P.J.L.
        • Alasnag M.
        • Rodriguez A.E.
        • Moschovitis A.
        • Laanmets P.
        • Donahue M.
        • Leonardi S.
        • Smits P.C.
        • MASTER DAPT Investigators
        Dual antiplatelet therapy after PCI in patients at high bleeding risk.
        N. Engl. J. Med. 2021 Oct 28; 385: 1643-1655
        • De Luca G.
        • Damen S.A.
        • Camaro C.
        • Benit E.
        • Verdoia M.
        • Rasoul S.
        • Liew H.B.
        • Polad J.
        • Ahmad W.A.
        • Zambahari R.
        • Postma S.
        • Kedhi E.
        • Suryapranata H.
        • Collaborators.
        Final results of the randomised evaluation of short-term dual antiplatelet therapy in patients with acute coronary syndrome treated with a new-generation stent (REDUCE trial).
        EuroIntervention. 2019 Dec 6; 15: e990-e998
        • Watanabe H.
        • Morimoto T.
        • Natsuaki M.
        • Yamamoto K.
        • Obayashi Y.
        • Ogita M.
        • Suwa S.
        • Isawa T.
        • Domei T.
        • Yamaji K.
        • Tatsushima S.
        • Watanabe H.
        • Ohya M.
        • Tokuyama H.
        • Tada T.
        • Sakamoto H.
        • Mori H.
        • Suzuki H.
        • Nishikura T.
        • Wakabayashi K.
        • Hibi K.
        • Abe M.
        • Kawai K.
        • Nakao K.
        • Ando K.
        • Tanabe K.
        • Ikari Y.
        • Morino Y.
        • Kadota K.
        • Furukawa Y.
        • Nakagawa Y.
        • Kimura T.
        STOPDAPT-2 ACS Investigators.Comparison of Clopidogrel Monotherapy after 1 to 2 months of dual antiplatelet therapy with 12 months of dual antiplatelet therapy in patients with acute coronary syndrome: The STOPDAPT-2 ACS Randomized Clinical Trial.
        JAMA Cardiol. 2022 Apr 1; 7: 407-417
        • Escaned J.
        • Cao D.
        • Baber U.
        • Nicolas J.
        • Sartori S.
        • Zhang Z.
        • Dangas G.
        • Angiolillo D.J.
        • Briguori C.
        • Cohen D.J.
        • Collier T.
        • Dudek D.
        • Gibson M.
        • Gil R.
        • Huber K.
        • Kaul U.
        • Kornowski R.
        • Krucoff M.W.
        • Kunadian V.
        • Mehta S.
        • Moliterno D.J.
        • Ohman E.M.
        • Oldroyd K.G.
        • Sardella G.
        • Sharma S.K.
        • Shlofmitz R.
        • Weisz G.
        • Witzenbichler B.
        • Pocock S.
        • Mehran R.
        Ticagrelor monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention: TWILIGHT-HBR.
        Eur. Heart J. 2021 Dec 1; 42: 4624-4634
        • Kim B.K.
        • Hong S.J.
        • Cho Y.H.
        • Yun K.H.
        • Kim Y.H.
        • Suh Y.
        • Cho J.Y.
        • Her A.Y.
        • Cho S.
        • Jeon D.W.
        • Yoo S.Y.
        • Cho D.K.
        • Hong B.K.
        • Kwon H.
        • Ahn C.M.
        • Shin D.H.
        • Nam C.M.
        • Kim J.S.
        • Ko Y.G.
        • Choi D.
        • Hong M.K.
        • Jang Y.
        • Investigators T.I.C.O.
        Effect of ticagrelor monotherapy vs ticagrelor with aspirin on major bleeding and cardiovascular events in patients with acute coronary syndrome: the TICO randomized clinical trial.
        JAMA. 2020 Jun 16; 323: 2407-2416https://doi.org/10.1001/jama.2020.7580
        • Wester A.
        • Mohammad M.A.
        • Olivecrona G.
        • Holmqvist J.
        • Yndigegn T.
        Koul validation of the 4-Item PRECISE-DAPT score: a SWEDEHEART study.
        S. J Am. Heart Assoc. 2021 Oct 19; 10 (e020974)https://doi.org/10.1161/JAHA.121.020974
        • Montalto C.
        • Crimi G.
        • Morici N.
        • Piatti L.
        • Grosseto D.
        • Sganzerla P.
        • Tortorella G.
        • De Rosa R.
        • De Luca L.
        • De Luca G.
        • Palmerini T.
        • Valgimigli M.
        • Savonitto S.
        • De Servi S.
        Bleeding risk prediction in elderly patients managed invasively for acute coronary syndromes: external validation of the PRECISE-DAPT and PARIS scores.
        Int. J. Cardiol. 2021 Apr 1; 328: 22-28https://doi.org/10.1016/j.ijcard.2020.11.065
        • Nardin M.
        • Verdoia M.
        • Barbieri L.
        • Schaffer A.
        • Suryapranata H.
        • De Luca G.
        Radial vs femoral approach in acute coronary syndromes: a meta- analysis of randomized trials.
        Curr. Vasc. Pharmacol. 2017; 16: 79-92
        • Bhatt D.L.
        • Cryer B.L.
        • Contant C.F.
        • et al.
        COGENT Investigators. Clopidogrel with or without omeprazole in coronary artery disease.
        N. Engl. J. Med. 2010; 363: 1909-1917
        • Gurbel P.A.
        • Erlinge D.
        • Ohman E.M.
        • et al.
        TRILOGY ACS platelet function substudy investigators. Platelet function during extended prasugrel and clopidogrel therapy for patients with ACS treated without revascularization: the TRILOGY ACS platelet function substudy.
        JAMA. 2012; 308: 1785-1794
        • Erlinge D.
        • Gurbel P.A.
        • James S.
        • et al.
        Prasugrel 5 mg in the very elderly attenuates platelet inhibition but maintains noninferiority to prasugrel 10 mg in nonelderly patients: the GENERATIONS trial, a pharmacodynamic and pharmacokinetic study in stable coronary artery disease patients.
        J. Am. Coll. Cardiol. 2013; 62: 577-583
        • Costa F.
        • van Klaveren D.
        • Colombo A.
        • Feres F.
        • Räber L.
        • Pilgrim T.
        • Hong M.K.
        • Kim H.S.
        • Windecker S.
        • Steyerberg E.W.
        • Valgimigli M.
        • PRECISE-DAPT Study Investigators
        A 4-item PRECISE-DAPT score for dual antiplatelet therapy duration decision-making.
        Am. Heart J. 2020 May; 223: 44-47
        • Urban P.
        • Mehran R.
        • Colleran R.
        • Angiolillo D.J.
        • Byrne R.A.
        • Capodanno D.
        • Cuisset T.
        • Cutlip D.
        • Eerdmans P.
        • Eikelboom J.
        • Farb A.
        • Gibson C.M.
        • Gregson J.
        • Haude M.
        • James S.K.
        • Kim H.S.
        • Kimura T.
        • Konishi A.
        • Laschinger J.
        • Leon M.B.
        • Magee P.F.A.
        • Mitsutake Y.
        • Mylotte D.
        • Pocock S.
        • Price M.J.
        • Rao S.V.
        • Spitzer E.
        • Stockbridge N.
        • Valgimigli M.
        • Varenne O.
        • Windhoevel U.
        • Yeh R.W.
        • Krucoff M.W.
        • Morice M.C.
        Defining high bleeding risk in patients undergoing percutaneous coronary intervention.
        Circulation. 2019 Jul 16; 140: 240-261