Outcome in the elderly undergoing percutaneous coronary intervention with sirolimus-eluting stents: results from the prospective multicenter German Cypher Stent Registry
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Published on: May 14, 2013
Marcus Wiemer1, Christoph Langer, Tanja Kottmann
1Heart and Diabetes Center, North Rhine Westfalia, University Bochum, Bad Oeynhausen, Germany.
Insights
Sirolimus-eluting stent (SES) implantation effectively relieved angina in elderly patients over 75. Despite higher baseline risks, major adverse cardiac events did not increase at 6 months, showing comparable safety outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Percutaneous coronary interventions (PCI) in patients >75 years carry increased risks of major adverse cardiac events (MACE), often influenced by comorbidities.
- Sirolimus-eluting stents (SES) have demonstrated efficacy in reducing in-stent restenosis and repeat revascularization across age groups.
Purpose of the Study:
- To evaluate the clinical outcomes of SES implantation in patients aged 75 years and older compared to younger patients.
- To assess the safety and efficacy of SES in an elderly population within a routine clinical setting.
Main Methods:
- Retrospective analysis of the German Cypher Registry.
- Comparison of outcomes between 954 patients >75 years and 5801 patients <75 years undergoing SES implantation.
Main Results:
- Elderly patients exhibited higher rates of renal failure, diabetes, hypertension, impaired left ventricular function, and 3-vessel disease.
- SES implantation provided significant angina relief in the elderly.
- While in-hospital and 6-month mortality were higher in the elderly, the rate of MACE (death, myocardial infarction, target vessel revascularization) at 6 months was similar between age groups.
Conclusions:
- Nonfatal complications, including myocardial infarction and repeat target vessel revascularization, did not increase with age in patients treated with SES.
- These findings extend to very elderly patients, including those over 80 years old.
Background:
Patients older than 75 years undergoing percutaneous coronary interventions are at increased risk for major adverse cardiac events strongly influenced by comorbidities. In various randomized trials, sirolimus-eluting stent (SES) implantation has been shown to decrease the incidence of in-stent restenosis and to reduce repeat revascularization regardless of patient age.
Methods:
The present study evaluates the outcome after SES implantation in 954 patients older than 75 years compared with 5801 patients younger than 75 years enrolled in the German Cypher Registry in a routine clinical setting.
Results:
The elderly were at higher risk regarding renal failure, diabetes, hypertension, impaired left ventricular function, and 3-vessel disease. The SES implantation resulted in an impressive relief of angina. As expected, in-hospital and 6-month mortality rates were higher in the elderly. However, there was no difference with respect to the rate of major adverse cardiac events (death, myocardial infarction, ischemia-driven target vessel revascularization) at 6-month follow-up.
Conclusions:
Nonfatal complications such as myocardial infarction or repeat target vessel revascularization did not increase with age, even taking patients older than 80 years into account.
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