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Published on: May 14, 2013
Drug-eluting stents in the elderly
Samip Vasaiwala1, Daniel E Forman, Laura Mauri
1Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Insights
Drug-eluting stents (DES) offer benefits for older adults with coronary artery disease, but raise bleeding concerns due to dual-antiplatelet therapy. Further research is needed to balance efficacy and safety in this population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Drug-eluting stents (DES) have transformed coronary artery disease management since 2003.
- Older adults face the highest burden of coronary artery disease and poorer outcomes.
- The use of DES in the elderly population presents unique challenges, particularly regarding bleeding risks associated with dual-antiplatelet therapy.
Purpose of the Study:
- To review the current literature on the effectiveness and safety of DES in elderly patients.
- To evaluate the risk-benefit profile of DES compared to bare metal stents in older adults.
- To address the controversy surrounding DES use in the elderly, considering age-related bleeding risks.
Main Methods:
- Systematic review of existing literature on DES therapy in elderly patients.
- Analysis of trial data and real-world evidence regarding DES use in older adults.
- Comparison of safety and efficacy outcomes between DES and bare metal stents in the elderly population.
Main Results:
- Trial data suggest a benefit of DES in elderly patients, but generalizability is limited due to exclusion criteria.
- Dual-antiplatelet therapy post-DES poses increased bleeding risks in older individuals.
- Newer antiplatelet agents may further elevate bleeding risks in this demographic.
Conclusions:
- The balance between DES efficacy and safety in elderly patients requires further clarification.
- Increased focus on the specific needs and risks of older adults undergoing DES implantation is warranted.
- As the population ages, understanding and optimizing DES therapy for the elderly is of growing importance.
Opinion Statement:
The introduction of drug-eluting stents (DES) in 2003 has had a great impact on the management of coronary artery disease in the United States. The application of DES to older adults, the population with the highest prevalence of and worst prognosis for coronary artery disease, remains relatively more controversial. Dual-antiplatelet therapy, which is recommended for at least 12 months after DES placement, is particularly problematic for older patients because of greater age-related bleeding risks. Unfortunately, few current data are available to gauge the balance of risk and benefit in elderly community-dwelling DES patients. Although trial data show a benefit for DES among elderly patients, many older adults typically are excluded from randomized trials because of comorbidities, making generalizability of DES safety based on trial data less certain. New, more potent thienopyridines may place the elderly at a particularly elevated bleeding risk. There is a fine balance between efficacy and safety for older DES patients that still needs to be clarified. As the population ages, these issues become more pervasive and of widespread concern. This review summarizes the current literature on DES therapy in the elderly, with a focus on effectiveness and safety profiles of DES versus bare metal stents.
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