Key result
Compared with drug-eluting stents, bare-metal stents were associated with higher 30-day mortality (OR 3.91; 95% CI 1.10-13.91; P=0.03) and 1-year MACE in octogenarians undergoing PCI.
Why the study?
Do drug-eluting stents (DES) improve clinical outcomes compared to bare-metal stents (BMS) in octogenarians undergoing percutaneous coronary intervention (PCI)?
Meta-Analysis
Do drug-eluting stents (DES) improve clinical outcomes compared to bare-metal stents (BMS) in octogenarians undergoing percutaneous coronary intervention (PCI)?
Odds Ratio: 3.91 (95% CI 1.1–13.91)
p-value: p=0.03
In octogenarians undergoing PCI, the use of drug-eluting stents is associated with favorable outcomes, including reduced MACE, MI, TVR, and stent thrombosis at 1 year compared to bare-metal stents.
DES may be preferred over BMS in octogenarians undergoing PCI; extends mixed evidence to this high-risk group.
OBJECTIVE: Uncertainty exists regarding the relative performance of drug-eluting stents (DES) versus bare-metal stents (BMS) in octogenarians undergoing percutaneous coronary intervention (PCI). We undertook a meta-analysis to assess outcomes for DES and BMS in octogenarians undergoing PCI. METHODS: Electronic data bases of PubMed, Cochrane, and EMBASE were searched. We included randomized, controlled clinical trials (RCT) and observational studies comparing DES and BMS in octogenarians receiving PCI. The methodological qualities of eligible trials were assessed using a "risk of bias" tool. The endpoints included all-cause death, major adverse cardiac events (MACE), myocardial infarction (MI), target vessel revascularization (TVR), major bleeding, and stent thrombosis (ST). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for each endpoint. RESULTS: A total of one RCT and six observational studies were included and analyzed in this meta-analysis. All trials were of acceptable quality. At 30 days, compared with DES-treated patients, BMS-treated patients had a higher incidence of mortality (OR: 3.91, 95% CI: 1.10-13.91; P = 0.03). The OR for MACE (1.52, 95% CI: 0.56-4.17; P = 0.13), MI (0.81, 95% CI: 0.37-2.17; P = 0.23), TVR (0.75, 95% CI: 0.17-3.41; P = 0.41), major bleeding (0.77, 95% CI: 0.35-1.68; P = 0.43), and ST (1.44, 95% CI: 0.32-6.45; P = 0.33) did not reach statistical significance. At one year follow-up, the OR did not favor BMS over MACE (MACE, defined as the composite of death, myocardial infarction, and TVR) (1.87; 95% CI: 1.22-2.87; P < 0.01), MI (1.91, 95% CI: 1.22-2.99; P < 0.01), TVR (3.08, 95% CI: 1.80-5.26; P < 0.01) and ST (3.37, 95% CI: 1.12-10.13; P < 0.01). The OR for mortality (1.51; 95% CI: 0.92-2.47; P = 0.10) and major bleeding (0.85, 95% CI: 0.47-1.55; P = 0.60) did not reach statistical significance. At > 1 year follow-up, the OR for all endpoints, including mortality, MACE, MI, TVR, major bleeding, and ST, did not reach statistical significance. CONCLUSIONS: Our meta-analysis suggests that DES is associated with favorable outcomes as compared with BMS in octogenarians receiving PCI.
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Gao et al. (2013) conducted a meta-analysis in Coronary artery disease requiring percutaneous coronary intervention. Drug-eluting stents (DES) vs. Bare-metal stents (BMS) was evaluated on 30-day mortality (OR 3.91, 95% CI 1.10-13.91, p=0.03). Compared with drug-eluting stents, bare-metal stents were associated with higher 30-day mortality (OR 3.91; 95% CI 1.10-13.91; P=0.03) and 1-year MACE in octogenarians undergoing PCI.
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