Key result
In older STEMI patients undergoing primary PCI, paclitaxel-eluting stents showed a trend toward lower MACE compared to bare-metal stents at 3 years (18.0% vs. 21.3%; P=0.07).
Why the study?
Does paclitaxel-eluting stent implantation reduce major adverse cardiac events compared to bare-metal stents in STEMI patients undergoing primary PCI across different age groups?
RCT (n=3,006)
3:1 ratio
Does paclitaxel-eluting stent implantation reduce major adverse cardiac events compared to bare-metal stents in STEMI patients undergoing primary PCI across different age groups?
Paclitaxel-eluting stents reduce ischemic target vessel revascularization compared to bare-metal stents in STEMI patients regardless of age, though they may increase major bleeding risk in elderly patients.
Answers are grounded in this paper and cite their sources.
Nonsignificant MACE trend with paclitaxel-eluting stents in older STEMI patients; leaves open optimal stent selection pending larger trials.
OBJECTIVES: To assess the impact of age on safety and efficacy of paclitaxel-eluting stent (PES) implantation during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: The benefits of paclitaxel-eluting stent (PES) implantation during primary PCI were confirmed by the long-term results of the HORIZONS-AMI trial. Whether the effects of PES are independent of age has not been reported. METHODS: Data on 3,006 patients from the HORIZONS-AMI study randomized in a 3:1 ratio to PES or bare-metal stent (BMS) in whom at least one stent was implanted were assessed. There were 2,302 (76.6%) patients <70, and 704 patients ≥70 years of age. RESULTS: At 3 years, among older patients a trend toward lower risk of major adverse cardiac events (MACE; death from any cause, stroke, reinfarction and unplanned revascularization for ischemia) related to PES use was observed (PES vs. BMS: 18.0% vs. 21.3%; P = 0.07). There was also a trend for reduction of MACE related to PES in older patients (26.4% vs. 33.1%; P = 0.09). Both, patients <70 and ≥70 years of age treated with PES were at lower risk for ischemic target vessel revascularization. However, a higher risk of major bleeding in elderly patients treated with PES was observed (P = 0.02 for interaction between age group and PES effects). No interaction between age and stent type in terms of the risk of other clinical end points, including all-cause death, was confirmed. CONCLUSIONS: For STEMI patients undergoing primary PCI, the implantation of PES as compared with BMS reduced ischemic TVR, and this effect was independent of age.
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Dudek et al. (2013) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=3,006). Paclitaxel-eluting stent (PES) vs. Bare-metal stent (BMS) was evaluated on Major adverse cardiac events (MACE; death from any cause, stroke, reinfarction and unplanned revascularization for ischemia) in older patients (p=0.07). In older STEMI patients undergoing primary PCI, paclitaxel-eluting stents showed a trend toward lower MACE compared to bare-metal stents at 3 years (18.0% vs. 21.3%; P=0.07).
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