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The current study examined the serum levels of receptor-interacting protein kinase 3 (RIPK3) in 51 patients with New York Heart Association (NYHA) class III-IV heart failure, 53 patients with myocardial infarction with ST elevation (STEMI), and 19 healthy subjects serving as a control group. An enzyme-linked immunoadsorbent assay (ELISA) was used to measure the levels of RIPK3 expression in serum. The area under the receiver operating characteristic curve (AUC) was then used to evaluate the predictive performance of RIPK3 and troponin I in patients with STEMI. In patients with normal levels of troponin I prior to percutaneous coronary intervention (PCI), serum levels of RIPK3 and troponin I after PCI were sufficient to differentiate patients with a preserved left ventricular ejection fraction (LVEF) from those with impaired left ventricular function after PCI (AUC = 0.780 (95% CI: 0.565-0.995, p = 0.043) with a sensitivity of 76.9% and a specificity of 71.4% vs. AUC = 0.735 (95% CI: 0.530-0.941, p = 0.038) with a sensitivity of 88.2% and a specificity of 63.6% at the optimal cutoff values, respectively). Moreover, elevated levels of troponin I after PCI were associated with an increased risk of an LVEF < 50% prior to discharge (odds ratio, 1.014; 95 % CI, 1.001 to 1.027; p = 0.03), while elevated levels of RIPK3 were not associated with such a risk. The current findings suggest that in patients with normal levels of troponin I prior to PCI, serum levels of RIPK3 and troponin I can serve as a potential marker to identify patients with a decreased LVEF, thus possibly allowing an early shift to more intensive therapy. [ABSTRACT FROM AUTHOR]

Aims: Antiplatelet treatment in the elderly post percutaneous coronary interventions (PCI) remains a complex issue. Here we report the results of the pre-specified subgroup analysis of the GLOBAL LEADERS trial evaluating the long-term safety and cardiovascular efficacy of ticagrelor monotherapy among patients categorised according to the pre-specified cut-off value of 75 years of age., Methods and Results: This was a pre-specified analysis of the randomised GLOBAL LEADERS trial (n=15,991), comparing 23-month ticagrelor monotherapy (after one month of DAPT) with the reference treatment (12-month DAPT followed by 12 months of aspirin). Among elderly patients (>75 years; n=2,565), the primary endpoint (two-year all-cause mortality or new Q-wave core lab-adjudicated myocardial infarction [MI]) occurred in 7.2% and 9.4% of patients in the ticagrelor monotherapy and the reference group, respectively (hazard ratio [HR] 0.75, 95% confidence interval [CI]: 0.58-0.99, p=0.041; pint=0.23); BARC-defined bleeding type 3/5 occurred in 5.2% and 4.1%, respectively (HR 1.29, 95% CI: 0.89-1.86; p=0.180; pint=0.06). The elderly with stable CAD had a higher rate of BARC 3/5 type bleeding (HR 2.05, 95% CI: 1.18-3.55) with ticagrelor monotherapy versus the reference treatment (pint=0.02). Elderly patients had a lower rate of definite or probable stent thrombosis (ST) with ticagrelor monotherapy (0.4% vs 1.4%, p=0.015, pint=0.01), compared with the reference group., Conclusions: In this pre-specified, exploratory analysis of the overall neutral trial, there was no differential treatment effect of ticagrelor monotherapy (after one-month dual therapy with aspirin) found in elderly patients undergoing PCI with respect to the rate of the primary endpoint of all-cause death or new Q-wave MI. The lower rate of ST in the elderly with ticagrelor monotherapy is hypothesis-generating. ClinicalTrials.gov identifier: NCT01813435.