Long-Term Paclitaxel-Eluting Stent Outcomes in Elderly Patients

Abstract

Background-Although drug-eluting stents have become a mainstay of percutaneous coronary intervention, information about drug-eluting stents outcomes in elderly patients is limited. Data from the paclitaxel-eluting stent (PES) trials and registries were pooled to assess PES benefits relative to advancing patient age, including comparison with bare-metal stents. Methods and Results-Data from 5 randomized trials (2271 patients with PES, 1397 patients with bare-metal stents) and from 2 postmarket registries (7492 patients with PES) were pooled separately. Each dataset was stratified into age groups: Ͻ60, 60 to 70, and Ͼ70 years. At baseline, patients aged Ͼ70 years in both datasets had significantly more adverse characteristics than younger patients. Through 5 years, trial data showed that patients aged Ͼ70 years had higher death rates, but comparable rates of myocardial infarction, stent thrombosis, and target lesion revascularization with younger patients. Compared with patients with bare-metal stents, patients with PES aged Ͼ70 years had comparable rates of death, myocardial infarction, and stent thrombosis but a significantly lower target lesion revascularization rate (22.2 versus 10.2, PϽ0.001). These findings were echoed in the registry data through 2 years that showed that PES patients aged Ͼ70 years had significantly higher death rates, but lower myocardial infarction, stent thrombosis, and target lesion revascularization rates, compared with younger patients. Although the mortality rates of patients aged Ͼ70 years were higher than those of younger patients, they were comparable with those of age-and gender-matched norms in the general population. Conclusions-This analysis of almost 10 000 patients demonstrated that percutaneous coronary intervention with PES is a safe and an effective treatment option that should not be withheld based on age. (Circ Cardiovasc Intervent. 2009; 2:178-187.)

Percutaneous Coronary Intervention in Very Elderly Patients. In-hospital Mortality and Clinical Outcome

“…These findings were echoed in the registry data through two years that showed that PES patients aged >70 years (2472 patients) had significantly higher death rates, but lower myocardial infarction, stent thrombosis and target lesion revascularisation rates, compared with younger patients. Although the mortality rates of patients aged >70 years were higher than those of younger patients, they were comparable with those of age-and gender-matched norms in the general population [16]. The authors of another study involving a retrospective cohort of elderly Medicare beneficiaries ages 66 and older (mean age of patients in the final analytic cohorts 75 years) treated with coronary stents between 2002 and 2003, reported that among elderly Medicare beneficiaries receipt of DES was associated with a statistically significant reduction in the rate of subsequent revascularisation procedures, decreasing rates of subsequent hospitalisation for acute myocardial infarction and improved survival [17].…”

Paclitaxel‐ and sirolimus‐eluting stents in older patients with diabetes mellitus

“…This might explain the relatively higher mortality rate observed in our study population when compared to previous report on diabetic population [17,18]. Nevertheless, the mortality rate of our study population was similar to that reported in other series focused on elderly patients [19][20][21], especially in the !75 years old group, probably because the life expectancy of these patients is naturally reduced [22,23].On the contrary the TLR rate at a median follow-up of 2-year was comparable to previous studies [14,16,[24][25][26]. Regarding the impact of the stent choice on outcome, we failed to find differences in term of outcome between the two DES.…”

Coronary Stenting With the GenousTM Bio-Engineered R StentTM in Elderly Patients - 12-Month Outcomes From the e-HEALING Registry -

“…16 A more recent publication regarding DES placement in the elderly concerns a pooled analysis of outcomes after paclitaxel-eluting stent placement. 17 In that analysis, registry patients aged 70 years or older showed low single-digit TLR rates at 2-year follow-up, which were lower than those observed in younger patients and explained by the authors as related to less aggressive atherosclerotic disease in the elderly. Altogether, our current study adds evidence to the current literature suggesting that the frequency of repeat revascularizations after coronary stenting is comparable with increasing age.…”