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Comparison Among Patients ≥75 Years Having Percutaneous Coronary Angioplasty Using Drug-Eluting Stents Versus Bare Metal Stents

Published:February 16, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.01.557
      Limited data are available on long-term efficacy and safety of drug-eluting stents (DES) in elderly patients who underwent PCI. A total of 635 consecutive patients aged ≥75 years who underwent PCI were enrolled at 2 European centers. Of these, 170 patients received at least 1 DES, whereas 465 patients received bare metal stent (BMS) only. Primary end point was the incidence of net adverse clinical events (NACE), defined as the occurrence of ischemic events or bleeding events, and was compared at a median follow-up of 31.2 months. Clinical follow-up information was available in 593 patients (93.4%). The duration of dual antiplatelet therapy was 12.3 ± 5.1 months in the DES group and 3.8 ± 7.4 months in the BMS group. The Kaplan-Meier estimate of NACE at 5 years was significantly lower in DES-treated patients (40.5%) than in BMS-treated patients (55.7%; p = 0.009). This benefit was driven by a significant reduction in myocardial infarction (8.6% vs 16.6%; p = 0.038) and target vessel revascularization rates (7.9% vs 21.9%; p = 0.003) in the DES group, with no significant increase in the incidence of bleeding events (13.8% vs 12.2%; p = 0.882). These results were confirmed at propensity score–adjusted Cox proportional hazard analysis. In conclusion, in patients ≥75 years, the use of DES compared with BMS seems to reduce myocardial infarction and repeat revascularization rates at long-term follow-up, without an increase in bleeding despite longer duration of dual antiplatelet therapy. This net clinical benefit, resulting from persistent efficacy and safety over time, may support the use of DES as a reasonable option in patients ≥75 years.
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