Key result
Octogenarians treated with new-generation DES had higher unadjusted target vessel failure than younger patients (7.3% vs 5.3%; HR 1.36, P=0.04), but age ≥80 was not independently associated with TVF.
Why the study?
Patients aged ≥80 years are often treated with new-generation DES, but randomized trial data are scarce due to underrepresentation.
Do octogenarians treated with new-generation drug-eluting stents have worse 1-year clinical outcomes compared to younger patients?
Meta-Analysis (n=9,204)
Yes
Do octogenarians treated with new-generation drug-eluting stents have worse 1-year clinical outcomes compared to younger patients?
Treatment of octogenarians with new-generation drug-eluting stents is safe and effective, as age ≥80 years is not independently associated with target vessel failure despite higher unadjusted rates of cardiac death and bleeding.
Age ≥80 should not alter new-generation DES selection; confirms TVF risk is driven by comorbidities rather than age.
BACKGROUND: Patients aged ≥80 years are often treated with new-generation drug-eluting stents (DES), but data from randomized studies are scarce owing to underrepresentation in most trials. We assessed 1-year clinical outcome of octogenarians treated with new-generation DES versus younger patients. METHODS: We pooled patient-level data of 9,204 participants in the TWENTE, DUTCH PEERS, BIO-RESORT, and BIONYX (TWENTE I-IV) randomized trials. The main clinical end point was target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction (MI), or clinically indicated target vessel revascularization. RESULTS: The 671 octogenarian trial participants had significantly more comorbidities. TVF was higher in octogenarians than in 8,533 patients <80 years (7.3% vs 5.3%, hazard ratio [HR]: 1.36, 95% CI: 1.0-1.83, P = .04). The cardiac death rate was higher in octogenarians (3.9% vs 0.8%, P < .001). There was no significant between-group difference in target vessel MI (2.3% vs 2.3%, P = .88) and repeat target vessel revascularization (1.9% vs 2.8%, P = .16). In multivariate analyses, age ≥ 80 years showed no independent association with TVF (adjusted HR: 1.04, 95% CI: 0.76-1.42), whereas the risk of cardiac death remained higher in octogenarians (adjusted HR: 3.38, 95% CI: 2.07-5.52, P < .001). In 6,002 trial participants, in whom data on major bleeding were recorded, octogenarians (n = 459) showed a higher major bleeding risk (5.9% vs 1.9%; HR: 3.08, 95% CI: 2.01-4.74, P < .001). CONCLUSIONS: Octogenarian participants in 4 large-scale randomized DES trials had more comorbidities and a higher incidence of the main end point TVF. Cardiac mortality was higher in octogenarians, whereas there was no increase in MI or target vessel revascularization rates. Treatment of octogenarian patients with new-generation DES appears to be safe and effective.
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Ploumen et al. (2020) conducted a meta-analysis in Coronary artery disease requiring new-generation drug-eluting stents (n=9,204). Age ≥80 years vs. Age <80 years was evaluated on target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction (MI), or clinically indicated target vessel revascularization (HR 1.36, 95% CI 1.0-1.83, p=.04). Octogenarians treated with new-generation DES had higher unadjusted target vessel failure than younger patients (7.3% vs 5.3%; HR 1.36, P=0.04), but age ≥80 was not independently associated with TVF.
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