Key result
Drug-eluting stents for in-stent restenosis in elderly patients were associated with a lower risk of death compared with bare metal stents (HR 0.72; 95% CI 0.66-0.80; P<0.001).
Why the study?
Does the use of drug-eluting stents improve long-term outcomes (death, MI, revascularization, stroke, bleeding) in elderly patients treated for in-stent restenosis compared to balloon angioplasty or bare metal stents?
Observational (n=43,679)
Yes
Does the use of drug-eluting stents improve long-term outcomes (death, MI, revascularization, stroke, bleeding) in elderly patients treated for in-stent restenosis compared to balloon angioplasty or bare metal stents?
Effect estimate: HR 0.72 (95% CI 0.66-0.80)
p-value: p=< 0.001
In elderly patients undergoing PCI for in-stent restenosis, the use of drug-eluting stents is associated with lower mortality and reduced risk of MI and revascularization compared to bare metal stents or balloon angioplasty.
Supports DES consideration in elderly ISR; leaves open need for RCTs to confirm benefit.
OBJECTIVE: We assessed the long-term outcomes of elderly patients who had in-stent restenosis (ISR) treated with drug-eluting stents (DES) compared with other treatment strategies. BACKGROUND: Elderly patients with ISR represent a vulnerable group of which little is known regarding the safety and efficacy of repeat percutaneous coronary intervention (PCI). METHODS: We analyzed patients ≥ 65 years of age who underwent PCI for ISR in the National Cardiovascular Data Registry(®) from 2004 to 2008. Death, myocardial infarction (MI), revascularization, stroke, and bleeding were assessed for up to 30 months by a linkage with Medicare rehospitalization claims. RESULTS: Of 43,679 linked patients, 30,012 were treated with DES, 8,277 with balloon angioplasty (BA), and 4,917 with bare metal stents (BMS). Compared with BMS, DES use was associated with a lower propensity score-matched (PM) risk of death (hazard ratio [HR] 0.72; 95% confidence interval [CI] 0.66-0.80, P < 0.001), MI (HR 0.81; 95% CI 0.70-0.93, P = 0.003), and revascularization (HR 0.90; 95% CI 0.82-1.00, P = 0.055). Compared with BA, DES use was associated with a lower PM risk of death (HR 0.82; 95% CI 0.76-0.89, P < 0.001) and revascularization (HR 0.86; 95% CI 0.80-0.93, P < 0.001), but no statistically significant difference across other endpoints. There were no significant differences in long-term outcomes for BA compared with BMS. CONCLUSIONS: There was lower mortality and reduced risk for MI, revascularization, and stroke, but a similar rate of bleeding with DES compared with other modalities. Our results indicate that DES use is a comparatively effective strategy to treat elderly patients with ISR.
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Kutcher et al. (2013) conducted an observational in In-stent restenosis (n=43,679). Drug-eluting stents (DES) vs. Bare metal stents (BMS) and balloon angioplasty (BA) was evaluated on Death (HR 0.72, 95% CI 0.66-0.80, p=< 0.001). Drug-eluting stents for in-stent restenosis in elderly patients were associated with a lower risk of death compared with bare metal stents (HR 0.72; 95% CI 0.66-0.80; P<0.001).
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