Drug-eluting stents in octogenarians: early and intermediate outcome

Large randomized controlled trials have demonstrated that percutaneous coronary intervention with the routine use of drug-eluting stents is safe and effective. However, octogenarians are usually excluded from these trials.

We analyzed 2453 consecutive patients who underwent DES implantation at the Mayo Clinic (Rochester, MN). The patients were classified in 2 age groups: patients > or = 80 years of age < or = 79 years of age.

Patients > or = 80 years old had significantly more adverse baseline characteristics including more comorbid conditions and more severe extensive coronary artery disease. Procedural success was high irrespective of the age group--97% in patients > or = 80 years of age versus 98% in the younger patients. Multivariate analysis demonstrated that age of > or = 80 years was significantly associated with inhospital major adverse cardiac events (MACEs) (P = .004). In addition, among inhospital survivors, octogenarians also had higher follow-up MACE rates (P < .001). At 12 months of follow-up, patients > or = 80 years of age had a mortality of 8.9% versus 3.0% for the younger patients (P < .001). The older patients also had more recurrent myocardial infarction (5.2% vs 2.6%, P = .019). However, there was no significant difference in 12-month target lesion revascularization (4.5% vs 4.9% [> or = 80 years of age vs < or = 79 years of age]) or coronary artery bypass grafting (1.8% vs 1.3% [> or = 80 years of age vs < or = 79 years of age]). After age-sex adjustment, life expectancy of octogenarians was similar to that of the general population (P = .78).

This study showed that drug-eluting stent implantation in octogenarians has high initial procedural success rates compared with the younger patients despite having more severe baseline risk characteristics. During follow-up, death and overall MACE rates remain higher in octogenarians but target lesion revascularization rates are similar.