Age related differences in acute coronary syndrome: An observation at a central hospital in Vietnam

Abstract Background and Objectives There is little data regarding the characteristics of young Vietnamese patients (<40 years old) who get acute coronary syndrome (ACS). This study aimed to compare the risk factors, clinical-subclinical characteristics, coronary lesions, and mortality prediction (based on the GRACE and TIMI scores) of young ACS patients with their older counterparts. Methods A cross-sectional descriptive study was conducted amongst 69 patients with ACS at the Cardiovascular Center of Hue Central Hospital from May 2017 to December 2018. These patients were divided into two groups: 33 patients were < 40 years old (group 1), and 36 patients were ≥ 40 years old (group 2). Demographic data, risk factors profile, clinical-subclinical characteristics, coronary lesions, and mortality prediction were compared between the two groups. Results Compared with group 2, group 1 had a higher proportion of severe angina (the prevalence of angina graded III-IV by CCS classification was 69.7% in group 1 versus 36.1% in group 2, P = 0.0108) and lower systolic pressure (median was 120 mmHg in group 1 versus 135 mmHg in group 2, P = 0.006). The prevalence of unstable angina and STEMI was higher in group 1 (51.5% and 36.4% in group 1 versus 30.6% and 11.1% in group 2, respectively), while NSTEMI was higher in group 2 (58.3% in group 2 versus 12.1% in group 1, P = 0.0002). The prevalence of single-vessel CAD, normal coronary angiography (CAG), nonobstructive CAD in group 1 was also higher and multi-vessel CAD was lower than group 2 (45.5%, 33.3%, 12.1% and 9.1% in group 1 versus 33.3%, 2.8%, 2.8% and 61.2% in group 2, respectively). The Gensini, GRACE, and TIMI scores were lower in group 1 (median was 5; medium was 78.55 and median was 2 in group 1 versus 37.5, 130.22 and 3 in group 2, respectively). Smoking was a risk factor for obstructive CAD in group 1 (OR = 7.12, 95% CI: 1.25–40.63, P < 0.05). Conclusion Young patients with ACS tended to be males, smokers, and with positive familial history; the grade of angina was more severe, and systolic pressure was lower; the prevalence of unstable angina and STEMI was higher. Smoking was a risk factor for obstructive CAD in young patients.

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Association of Haemoglobin and C-Reactive Protein level with Different Risk Factors among Acute Coronary Syndrome Patients

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i2.43022 ◽

2019 ◽

Vol 5 (2) ◽

pp. 156-160

Author(s):

Md Mahboob Morshed ◽

Md Joynul Islam ◽

ATM Ashadullah ◽

Khondker Shaheed Hussain ◽

Mohammad Ahtashamul Haque

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Reactive Protein ◽

Coronary Syndrome ◽

Group 4 ◽

History Of ◽

Study Population ◽

Group 3 ◽

Group 2 ◽

Group 1

Background: Different risk factors may be related with the haemoglobin and CRP level among the acute coronary syndrome patients. Objective: The purpose of the present study was to see the association of haemoglobin and CRP level with different type of risk factors among the acute coronary syndrome patients. Methodology: This cross-sectional study was conducted in the Department of Cardiology at Mymensingh Medical College, Mymensingh, Bangladesh from December 2010 to November 2011 for a period of two (02) years. Patients of ACS who were presented within 12 hours of chest pain were included as study population. Study population were categorized in four groups according to the level of hemoglobin and C-reactive protein. Age, cardiovascular risks factor, history, family history of cardiovascular disease, treatment history and ECG were taken during admission. Blood sample was collected for baseline laboratory investigations like Troponin-I, Random Blood Sugar (RBS), Blood urea, Serum creatinine, lipid profile, Hemoglobin & CRP level. Sample were then send to standard laboratory/Biochemistry department of MMCH. Result: The mean age of the population was 52.18±8.88 years. Smoking was the highest percentage in Group 1 which was 54(50.0%) cases (P=0.001). Hypertension was found most common in group 1 (47.6%), Group 2 (33.3%), Group 3 (10.7%) and Group 4 (8.3%). Smoking (p=0.001) and hypertension (p=0.016) was found statistically significant. Diabetes was found in Group 1 (37.7%), Group 2 (43.5%), Group 3 (11.6%) and Group 4 (7.2%). Group 1 (50%) and Group 2 (50%) patients were dyslipidaemic. Family history of IHD was present group-1 (36.8%), Group 2 (44.7%), Group 3 (73.2%) and Group 4 (53%). Among the smoker patient 65.6% cases had CRP level ˃12 mg/l; 39.8% cases had CRP level ˂12mg/L. Among the nonsmoker 34.4% cases had CRP level ˃12mg/l and 60.2% cases had CRP level ˂12mg/L. The finding was statistically significant. Conclusion: In conclusion haemoglobin and CRP level is associated with different type of risk factors among the acute coronary syndrome patients. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 156-160

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A study of risk factors and coronary angiographic profile in young patients with acute coronary syndrome

Indian Heart Journal ◽

10.1016/j.ihj.2020.11.028 ◽

2020 ◽

Vol 72 ◽

pp. S6-S7

Author(s):

Bodhisattya Roy Chaudhuri ◽

Ram Pratap Saini ◽

Sandeep Bansal

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Young Patients ◽

Coronary Syndrome

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The Threshold of Admission Glycemia as a Predictor of Adverse Events in Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome

Clinical medicine Cardiology ◽

10.4137/cmc.s2289 ◽

2009 ◽

Vol 3 ◽

pp. CMC.S2289 ◽

Cited By ~ 3

Author(s):

Taysir S. Garadah ◽

Salah Kassab ◽

Qasim M. Al-Shboul ◽

Abdulhai Alawadi

Keyword(s):

Acute Coronary Syndrome ◽

Adverse Events ◽

Diabetic Patients ◽

Stress Hyperglycemia ◽

Coronary Syndrome ◽

History Of ◽

Group 3 ◽

Group 2 ◽

High Level ◽

Group 1

Recent studies indicated a high prevalence of hyperglycemia in non-diabetic patients presenting with acute coronary syndrome (ACS). However, the threshold of admission glucose (AG) as a predictor of adverse events in ACS is unclear. Objective The aim of this study was to assess the threshold of admission glucose (AG) as a predictor of adverse events including Major Acute Cardiac Events (MACE) and mortality, during the first week of admitting patients presenting with ACS. Material and Methods The data of 551 patients with ACS were extracted and evaluated. Patients were stratified according to their blood glucose on admission into three groups: group 1: <7 mmol/L (n = 200, 36.3%) and group 2: >7 mmol/L and <15 mmol/L (n = 178, 32.3%) and group 3: ≥15 mmol/L (n = 173, 31.4%). Stress hyperglycemia was arbitrarily defined as AG levels > 7 mmol/L (group 2 and 3). Patients with ACS were sub-divided into two groups: patients with unstable angina (UA, n = 285) and those with ST segment elevation myocardial Infarction (STEMI, n = 266) and data were analyzed separately using multiple regression analysis. Results The mean age of patients was 59.7 ± 14.8 years and 63% were males. The overall mortality in the population was 8.5% (5.4% in STEMI and 3.1% in UA) patients. In STEMI patients, the odds ratio of stress hyperglycemia as predictor of mortality in group 3 compared with group 1 was 3.3 (CI 0.99-10.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.75-8.07, P = 0.065) after adjustment for age and sex. Similarly, in UA patients, the odds ratio of stress hyperglycemia in group 3 compared with group 1 was 2.7 (CI 0.37-18.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.4-15.2, P = 0.344) after adjustment for age and sex. The incidence of more than 2 MACE in both STEMI and UA patients was higher in group 3 compared with the other two groups. Regression analysis showed that history of DM, high level of LDL cholesterol, high level of HbA1c, and anterior infarction were significant predictors of adverse events while other risk factors such as BMI, history of hypertension and smoking were of no significance. Conclusion This study indicates that the stress hyperglycemia on admission is a powerful predictor of increased major adverse events and hospital mortality in patients with acute coronary syndrome.

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P4624Predictive performance of CRUSADE bleeding score in non ST elevation acute coronary syndrome patients treated with ticagrelor versus clopidogrel

European Heart Journal ◽

10.1093/eurheartj/ehz745.1006 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Graca Santos ◽

F Montenegro Sa ◽

C Ruivo ◽

R Ribeiro Carvalho ◽

J Correia ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Predictive Performance ◽

Roc Curves ◽

National Registry ◽

Red Blood Cell Transfusion ◽

Coronary Syndrome ◽

St Elevation ◽

Group 2 ◽

Risk Categories ◽

Group 1

Abstract Introduction CRUSADE score is commonly used for bleeding risk stratification in the context of acute coronary syndrome (ACS). However, the study validating it was performed before ticagrelor was available. Purpose To compare the predictive performance of CRUSADE score in two groups of non-ST elevation ACS (NSTEACS) patients, one treated with ticagrelor and another with clopidogrel. Methods Retrospective study of 2077 NSTEACS patients admitted between January 2014 and September 2017 and included in a multicentre national registry. Group 1 was composed by patients medicated with ticagrelor, and Group 2 with clopidogrel. Patients with bleeding history were excluded. The primary endpoint (PE) results from a composite which includes: in-hospital major bleeding (MB) according to the Registry criteria, need for red blood cell transfusion (RBCT), or haemoglobin drop ≥2g/dL (HbD). The groups were compared according to their demographic, clinical and laboratory characteristics. The occurrence of the PE (and its components) across CRUSADE risk categories was assessed by Chi-square for linear trend. The performance of CRUSADE score for PE prediction in each cohort was assessed by Receiver Operator Characteristics (ROC) curves. Results Group 1 included 662 (31.9%) and Group 2 1415 (68.1%) patients. Mean CRUSADE score was higher in Group 2 (23.1±14.7 versus (vs) 26.7±16.3, p=0.001). No difference was observed regarding the PE (14.8% vs 17.0%, p=0.200) and its components. With the exception of MB in Group 1 (p-trend=0.425), the relative occurrence of the PE and its components increased across CRUSADE risk categories [Figure 1. panel A]. In-hospital mortality was numerically superior in Group 2, but did not reach statistical significance (1.1% vs 1.6%, p=0.368). In both groups, the performance of CRUSADE score in predicting the PE was modest (Group 1 AUC=0.59 and p=0.006, Group 2 AUC=0.62 and p<0.001), and no difference was observed when comparing the two groups (P value for ROC curves comparison = 0.899) [Figure 1. panel B and C respectively]. Figure 1 Conclusion In this study based on a national registry of NSTEACS patients, the use of ticagrelor did not influence the occurrence of bleeding related events and it did not change the predictive performance of the CRUSADE score. According to this analysis, CRUSADE score may be applied without limitation to NSTEACS patients managed with ticagrelor.

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Gender Differences in Clinical, Angiographic and Procedural Profiles between Young Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention

Cardiovascular Journal ◽

10.3329/cardio.v10i2.36277 ◽

2018 ◽

Vol 10 (2) ◽

pp. 113-120

Author(s):

Fathima Aaysha Cader ◽

Afzalur Rahman ◽

Mohammad Ullah ◽

Mohammad Arifur Rahman ◽

Md Sarwar Alam ◽

...

Keyword(s):

Risk Factors ◽

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Young Women ◽

Young Patients ◽

Coronary Intervention ◽

Young Males ◽

Young Females ◽

Coronary Syndrome ◽

Percutaneous Coronary

Background: Acute coronary syndrome (ACS) is increasingly prevalent among young patients, particularly in South Asia, where young patients are known to present with multiple risk factors and gender-based differences in angiographic profiles. This study aimed to compare gender differences in clinical, angiographic and procedural profiles between young patients with ACS undergoing percutaneous coronary intervention (PCI).Methods: This prospective observational study was done at the National Institute of Cardiovascular Diseases (NICVD) from April 2016 to March 2017. 190 young patients with ACS undergoing PCI were included. Clinical, angiographic and procedural variables were compared and statistically analyzed.Results: The mean age of young females and males was 43.8±6.9 years and 40.1±4.3 years respectively (p<<0.001). Young women had significantly more risk factors of hypertension (62.1% vs 33.7%, p<0.001) and diabetes (57.9% vs 31.6%, p<0.001) in comparison to young men. Smoking was significantly greater among young males (70.5% vs 0%, p<0.001). Young females had significantly better mean ejection fraction (EF) (48.4±9.3% vs 45.1±10.4%, p=0. 02). Left main coronary artery (3.2% vs. 1.1%, p=0.61) and left anterior descending artery (51.6% vs. 45.3%, p=0.38) were more frequently involved among young females. Young males showed angiographically more severe CAD and greater frequency of multivessel CAD with higher DVD (22.1%vs 18.9%, p=0.58) and TVD (18.9%vs 11.6%, p=0.15).Conclusion: Significantly more young women with ACS presented with hypertension and diabetes than young males. However, they had better ejection fraction and less severe angiographic profiles.Cardiovasc. j. 2018; 10(2): 113-120

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P977 CT phenotype of high-risk atherosclerotic plaques causing an acute coronary syndrome compared to silent vulnerable plaques

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.607 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

R I Hodas ◽

D Opincariu ◽

N Rat ◽

I Rodean ◽

M Chitu ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Morphological Characteristics ◽

Plaque Morphology ◽

Atherosclerotic Plaques ◽

Plaque Instability ◽

Coronary Syndrome ◽

Atheromatous Plaques ◽

Group 2 ◽

Group 1

Abstract Funding Acknowledgements PlaqueImage.- research grant no. 103544/2016, contract number 26/01.09.2016 - Background Previous studies demonstrated that plaque morphology has a crucial role in the development of an acute coronary syndrome (ACS). However, not all vulnerable coronary plaques produce an ACS and the prediction power of various vulnerability features to predict an acute coronary event in a close future, has not been elucidated so far. Objective We aimed to use multi-slice computed tomography angiography (CTA) for assessment of morphological characteristics of culprit lesions producing an ACS in the next several months after CT assessment, in comparison with morphological characteristics of unstable coronary atherosclerotic plaques which did not trigger an ACS. Material and methods We analyzed 40 patients in whom CTA revealed presence of unstable coronary lesions, exhibiting at least one marker of vulnerability: napkin ring sign (NRS), spotty calcium (SC), positive remodeling (PR) or presence of low attenuation plaque (LAP), divided in 2 groups: group 1 - 20 patients who developed an ACS in the next 6 months following CTA examination, and group 2 – 20 patients matched for age, gender and risk factors, who did not present any cardiovascular event 6 month after CTA assessment. Post-processing of multi-slice CTA images was performed in order to assess morphological characteristics and CT-derived markers of atherosclerotic plaque instability. Results Similar mean values of plaque length (17.1 +/- 5.9 mm vs 16.9 +/- 3.4 mm; p = 0.6) and total atheroma volume (188.1 +/- 104.7 mm3vs 186.4 +/- 90.7 mm3; p = 0.8) were obtained for both groups. The mean number of vulnerability markers was 1.6 in group 1 vs 1.2 in group 2 (p = 0.07). However, atherosclerotic lesions in patients from group 1 presented significantly higher values of lipid-rich atheroma (9.8 +/- 10.8 mm3vs 2.6 +/- 1.0 mm3; p = 0.01) and remodeling index (1.14 +/- 0.3 in group 1 vs 0.89 +/- 0.19 in group 2, p = 0.04). At the same time, atheromatous plaques in patients who developed an ACS during the 6-months follow-up showed in a significantly higher proportion LAP (45% in group vs 10% in group 2, p = 0.03) and PR (15%in group 1 versus 5% in group 2, p = 0.04), but not NRS (30% vs 25%, p = ns) or SC (65% vs 40%, p = 0.2). Conclusions Atherosclerotic plaques producing an ACS exhibit a different phenotype than unstable plaques that remain silent. The CTA profile of atheromatous plaques producing an ACS includes the presence of low attenuation, positive remodeling, higher RI and lipid-rich atheroma. Presence of these features in high-risk coronary plaques identifies very high risk patients, who can benefit from adapted therapeutic strategy in order to prevent the development of an ACS.

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Thrombosis risk factors and gene mutations in young age patients with acute coronary syndrome

Kardiologiia ◽

10.18087/cardio.2602 ◽

2019 ◽

Vol 59 (1S) ◽

pp. 19-24

Author(s):

I. V. Ponomarenko ◽

I. A. Sukmanova

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Young Patients ◽

Young Age ◽

High Density Lipoproteins ◽

Control Group ◽

Clinical Approach ◽

Biochemical Tests ◽

Coronary Syndrome ◽

Thrombosis Risk

Goal of research. Study the role of thrombosis risk factors and polymorphisms in genes in young age patients with acute coronary syndrome (ACS).Materials and methods. Te study included 299 patients of age 25 to 44 years old with ACS were treated from 2012 to 2017 at the department of myocardial infarction 1st KGBUZ Altay regional cardiological clinic. Te middle age of patients with ACS was 40.3 ± 0.2 years. Te control group included of 53 apparently healthy volunteers aged from 25 to 44 years old, the average age those patients was 39.94 ± 0.79 years. Also, those patients hadn’t any comorbid conditions. Te control group hadn’t any datas of ischemic heart disease by the results of exercise tolerance tests. All patients had standard clinical, anamnestic, biochemical tests, lipid profle, fasting plasma glucose, electrocardiogram, echocardiography and coronaroangiography, also they were determined growth and weight with body-weight index. 116 patients from the ACS group and 53 patients fromthe control group had screening of polymerase chain reaction for determine polymorphism of the FII genes G20210-A, FV G1691-A, and MTHFR C677-T.Results. We identifed the most signifcant sets of risk factors associated with ACS in young age patients based on our multifactorial statistical analysis with binary logistic regression. Tis combination of risk factors was: increased levels of low-density lipoproteins, decreased levels of high-density lipoproteins, smoking, existence of MTHFR homozygous polymorphism, heredity in combination with smoking, FV homozygote, MTHFR homozygote, smoking with MTHFR-homozygote.Conclusion. Te ability predicting the risk of developing cardiovascular disease in young people based on traditional risk factors, partly modifable, as well as the researching of "new" risk factors, opens up new opportunities for developing a clinical approach of treating young patients with high risk of ACS.

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Glycemic variability in type 2 diabetes mellitus and acute coronary syndrome: liraglutide compared with insulin glargine: a pilot study

Journal of International Medical Research ◽

10.1177/0300060520926063 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052092606

Author(s):

Maria Isabel del Olmo-García ◽

David Hervás Marín ◽

Jana Caudet Esteban ◽

Antonio Ballesteros Martin-Portugués ◽

Alba Cerveró Rubio ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Acute Coronary Syndrome ◽

Hospital Setting ◽

Glycemic Variability ◽

Coronary Syndrome ◽

Group 2 ◽

Group 1

Objective To explore the glucagon-like peptide-1 analogue liraglutide in the hospital setting in patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome and to evaluate the safety and efficacy and its impact on hospitalization and short-term glycemic variability (GV). Methods A 12-week, open-label, prospective, randomized pilot clinical study with parallel groups that compared liraglutide (group 1) with glargine (group 2) and its impact on glycemic control and GV. Results Thirteen patients were included. During hospitalization, mean glucose was 164.75 mg/dL (standard deviation [SD] 19.94) in group 1 and 166.69 mg/dL (38.22) in group 2. GV determined by CV and SD was 20.98 (7.68) vs. 25.48 (7.19) and 34.37 (13.05) vs. 43.56 (19.53) in groups 1 and 2, respectively. Group 1 prandial insulin requirements during hospitalization were lower compared with group 2. Follow-up A1c in group 1 was 6.9% (−1.51%) and 6.5% in group 2 (−1.27). GV after discharge and hypoglycemia were lower in group 1 compared with group 2. Conclusions Liraglutide seems to reduce GV in the acute phase of acute coronary syndrome, and patients achieved optimal control with a low incidence of hypoglycemia. These results support the need to explore liraglutide in a larger multicenter trial. Trial registration: The study was approved by the National Medical Ethics Committee of Spain. The study was registered at European Clinical Trials Database (EudraCT): 2014003298-40.

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Acute Coronary Syndrome in the Young - Risk Factors and Angiographic Pattern

Cardiovascular Journal ◽

10.3329/cardio.v2i2.6635 ◽

1970 ◽

Vol 2 (2) ◽

pp. 175-178 ◽

Cited By ~ 2

Author(s):

AFMS Haque ◽

AR Siddiqui ◽

SMM Rahman ◽

SA Iqbal ◽

NN Fatema ◽

...

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Risk Factor ◽

Older Patients ◽

Young Patients ◽

Military Hospital ◽

Coronary Risk Factors ◽

Coronary Risk ◽

Common Risk Factor ◽

Coronary Syndrome

Background: Coronary artery disease (CAD) is a worldwide health epidemic. Acute coronary syndrome is a potentially life-threatening condition and patient may die or become disabled in the prime of life. There is documented evidence that South Asian people develop CAD at a higher rate and also at an early age. If the affected individual is 40 yrs old or below, the tragic consequences are catastrophic. Methods: It was a retrospective observational study to find out the pattern of acute coronary syndrome in the young (40 years old or less) in a military hospital (CMH Dhaka) from July 2007 to July 2008 and to analyze the risk factors and the angiographic characteristics of coronary vessels. Consecutive 64 young patients including both male and female admitted into this hospital were the study subjects. Out of these patients 53 were males and 11 were females. Among these patients coronary risk factors and angiographic pattern were studied. 64 older patients with Acute coronary syndrome (age more than 40 years) were also studied. Results: Out of 64 young patients 15.6% patients presented to this hospital as UA, 9.37% presented as Non-Q MI, 28.12% Acute Anterior MI, 14.06% Acute Anteroseptal MI, 26.56% Acute Inferior MI, 6.25% Acute Infero-posterior MI. Smoking was the most common risk factor among these young patients. 64.06% patients were smoker. Dyslipidaemia was present among 50% patients, 37.55% were hypertensive, 15.62% were diabetic, and 15.62% were obese. SVCAD was the most common lesion and it was 53.12%. 26.56% patients had DVCAD and TVCAD was present among 20.31% patients. In the older group (more than 40 years) most common risk factor was dyslipidaemia (71.88%) and smoking was present among 48.43% patients. Conclusion: Young patients have a different risk factor profile in comparison with older patients. Smoking is a strong and quite common coronary risk factor in the young ACS patients who are 40 years or less. Risk factor identification and control is very crucial in the primary and secondary prevention in young patients with CAD. Keywords: Acute coronary syndrome; Risk factors; Coronary Angiography DOI: 10.3329/cardio.v2i2.6635Cardiovasc. j. 2010; 2(2) : 175-178

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Comparison of the efficacy of half ticagrelor loading doses and clopidogrel in elderly acute coronary syndrome patients in China

Tropical Journal of Pharmaceutical Research ◽

10.4314/tjpr.v19i3.29 ◽

2020 ◽

Vol 19 (3) ◽

pp. 661-666

Author(s):

Jian Xue ◽

Mingming Li ◽

Lijie Wang ◽

Minjun Ma ◽

Jin Zhang

Keyword(s):

Acute Coronary Syndrome ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Cardiac Events ◽

Coronary Syndrome ◽

Therapeutic Benefits ◽

Proportional Hazards Regression ◽

Elder Patients ◽

Group 2 ◽

Group 1

Purpose: To evaluate the effects of half-load doses (HLD) of ticagrelor and clopidogrel on elderly acute coronary syndrome patients (ACS) over a period of 90 days. Methods: Seventy-four patients diagnosed as ACS were included in this trial. The patients were randomly distributed into group 1 (treated with HLD ticagrelor, 90 mg LD) and group 2 (treated with clopidogrel, 300 mg LD). The interaction of treatment effect was evaluated using Multivariate Cox proportional hazards regression models. Results: Within three months, a total of 12 patients (16.21 %) died of myocardial infarction or stroke. The endpoint of HLD ticagrelor-treated elderly ACS patients was 20 %, and the incidence of clopidogreltreated endpoints was 14.81 %. Conclusion: In the first 45 patients treated with HLD ticagrelor, their cumulative incidence of cardiac events was relatively high. However, there were no considerable changes in the therapeutic benefits of these two drugs in elderly ACS patients. Keywords: Elder patients, Acute coronary syndrome, Ticagrelor, Clopidogrel

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