Key result
Elderly patients (≥70 years) treated with drug-eluting stents had a higher 12-month mortality rate than younger patients, while the use of second-generation stents reduced the risk of myocardial infarction in the elderly.
Why the study?
Does the use of second-generation drug-eluting stents reduce myocardial infarction and MACCE compared to first-generation drug-eluting stents in elderly patients undergoing percutaneous coronary intervention?
Observational (n=1,916)
Yes
Does the use of second-generation drug-eluting stents reduce myocardial infarction and MACCE compared to first-generation drug-eluting stents in elderly patients undergoing percutaneous coronary intervention?
In elderly patients undergoing PCI, the use of second-generation drug-eluting stents significantly reduced the risk of myocardial infarction at 12 months compared to first-generation stents.
Answers are grounded in this paper and cite their sources.
Second-generation DES were associated with lower MI risk in elderly PCI patients; hypothesis-generating and requires RCT confirmation before practice change.
BACKGROUND: Katowice-Zabrze registry provides data that can be used to evaluate clinical outcomes of percutaneous coronary interventions in elderly patients (≥70 y/o) treated with either first- (DES-I) or second-generation (DES-II) drug-eluting stents (DES). METHODS: The registry consisted of data from 1916 patients treated with coronary interventions using either DES-I or DES-II stents. For our study, we defined patients ≥70 years of age as elderly. We evaluated any major adverse cardiac and cerebral events (MACCE) at 12-month follow-up. RESULTS: Coronary angiography revealed a higher incidence of multivessel coronary artery disease in this elderly patient population. There were no differences in acute and subacute stent thrombosis (0.4 vs. 0.6%, p = 0.760; 0.4 vs. 0.4%; p = 0.712). Elderly patients experienced more in-hospital bleeding complications requiring blood transfusion (2.0 vs. 0.9%; p = 0.003). Resuscitated cardiac arrests (2.0 vs. 0.9%; p = 0.084) were observed more often in this elderly patients during hospitalization. The composite in-hospital MACCE rates did not differ statistically between both groups (1.4 vs. 1.1%; p = 0.567). Data from a twelve-month follow-up disclosed that mortality was higher (7.1 vs. 1.8%; p < 0.001) in the elderly, with no difference in TVR (7.2 vs. 9.9%, p = 0.075), MI (6.0 vs. 4.8%, p = 0.300), stroke (0.8 vs. 0.6%, p = 0.600) and composite MACCE (15.0 vs. 13.4%, p = 0.324). The age of 70 years or over was an independent predictor of death [HR = 2.55 (95% CI 1.49-4.37); p < 0.001]. The use of DES-II reduced the risk of MI [HR = 0.40 (95% CI 0.19-0.82); p = 0.012] in the elderly. CONCLUSION: This elderly patient population had an increased risk of in-hospital bleeding complications requiring blood transfusion and a higher risk of death at 12-month follow-up. The use of new-generation DES reduced the risk of MI in the elderly population.
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Wańha et al. (2016) conducted an observational in Acute coronary syndrome (n=1,916). Age ≥70 years vs. Age <70 years was evaluated on Composite of major adverse cardiac and cerebral events (MACCE) at 12-month follow-up (p=0.324). Elderly patients (≥70 years) treated with drug-eluting stents had a higher 12-month mortality rate than younger patients, while the use of second-generation stents reduced the risk of myocardial infarction in the elderly.
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