Journal article
Improved outcomes of elderly patients treated with drug-eluting versus bare metal stents in large coronary arteries: results from the BAsel Stent Kosten-Effektivitäts Trial PROspective Validation Examination randomized trial.
- Kurz DJ Cardiology, Triemli Hospital, Zurich, Switzerland. Electronic address: david.kurz@triemli.zuerich.ch.
- Bernheim AM Cardiology, Triemli Hospital, Zurich, Switzerland.
- Tüller D Cardiology, Triemli Hospital, Zurich, Switzerland.
- Zbinden R Cardiology, Triemli Hospital, Zurich, Switzerland.
- Jeger R Department of Cardiology, University Hospital, Basel, Switzerland.
- Kaiser C Department of Cardiology, University Hospital, Basel, Switzerland.
- Galatius S Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
- Hansen KW Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
- Alber H Cardiology, University Hospital, Innsbruck, Austria.
- Pfisterer M Department of Cardiology, University Hospital, Basel, Switzerland.
- Eberli FR Cardiology, Triemli Hospital, Zurich, Switzerland.
- 2015-09-21
Published in:
- American heart journal. - 2015
Aged
Coronary Angiography
Coronary Artery Disease
Coronary Vessels
Drug-Eluting Stents
Europe
Everolimus
Follow-Up Studies
Humans
Immunosuppressive Agents
Middle Aged
Percutaneous Coronary Intervention
Prospective Studies
Prosthesis Design
Sirolimus
Survival Rate
Treatment Outcome
English
BACKGROUND
Drug-eluting stents (DES) improve outcomes in elderly patients with small coronary artery disease compared with bare-metal stents (BMS), but randomized data in elderly patients in need of large coronary stents are not available.
METHODS
Planned secondary analysis of patients ≥75 years recruited to the "BASKET-PROVE" trial, in which 2,314 patients undergoing percutaneous coronary intervention for large (≥3.0 mm) native vessel disease were randomized 2:1 to DES (everolimus- vs sirolimus-eluting stents 1:1) versus BMS. All patients received 12 months of dual antiplatelet therapy. The primary end point was a composite of cardiac death or nonfatal myocardial infarction at 2 years.
RESULTS
Comparison of DES versus BMS among 405 patients ≥75 years showed significantly lower rates of the primary end point for DES (5.0% vs 11.6%; hazard ration (HR) 0.64 [0.44-0.91]; P = .014). Rates of nonfatal myocardial infarction (1.2% vs 5.5%, hazard ration (HR) 0.44 [0.21-0.83]; P = .009), all-cause death (7.4% vs 14.4%; HR 0.7 [0.51-0.95]; P = .02), and target vessel revascularization (TVR) (2.3% vs 6.2%; HR 0.59 [0.34-0.99]; P = .046) were also lower, whereas stent thrombosis and bleeding rates were similar. In contrast, among patients <75 years (n = 1,909), the only significant benefit of DES was a reduced rate of TVR (4.0% vs 8.7%, HR 0.66 [0.55-0.80]; P < .0001).
CONCLUSIONS
In patients ≥75 years requiring large (≥3.0 mm) coronary stents, use of DES was beneficial compared with BMS and reduced the rate of ischemic events, mortality, and TVR. These data suggest that DES should be preferred over BMS in elderly patients.
Drug-eluting stents (DES) improve outcomes in elderly patients with small coronary artery disease compared with bare-metal stents (BMS), but randomized data in elderly patients in need of large coronary stents are not available.
METHODS
Planned secondary analysis of patients ≥75 years recruited to the "BASKET-PROVE" trial, in which 2,314 patients undergoing percutaneous coronary intervention for large (≥3.0 mm) native vessel disease were randomized 2:1 to DES (everolimus- vs sirolimus-eluting stents 1:1) versus BMS. All patients received 12 months of dual antiplatelet therapy. The primary end point was a composite of cardiac death or nonfatal myocardial infarction at 2 years.
RESULTS
Comparison of DES versus BMS among 405 patients ≥75 years showed significantly lower rates of the primary end point for DES (5.0% vs 11.6%; hazard ration (HR) 0.64 [0.44-0.91]; P = .014). Rates of nonfatal myocardial infarction (1.2% vs 5.5%, hazard ration (HR) 0.44 [0.21-0.83]; P = .009), all-cause death (7.4% vs 14.4%; HR 0.7 [0.51-0.95]; P = .02), and target vessel revascularization (TVR) (2.3% vs 6.2%; HR 0.59 [0.34-0.99]; P = .046) were also lower, whereas stent thrombosis and bleeding rates were similar. In contrast, among patients <75 years (n = 1,909), the only significant benefit of DES was a reduced rate of TVR (4.0% vs 8.7%, HR 0.66 [0.55-0.80]; P < .0001).
CONCLUSIONS
In patients ≥75 years requiring large (≥3.0 mm) coronary stents, use of DES was beneficial compared with BMS and reduced the rate of ischemic events, mortality, and TVR. These data suggest that DES should be preferred over BMS in elderly patients.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ahj.2015.07.009
- PMID 26386803
- Persistent URL
- https://folia.unifr.ch/global/documents/73095
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