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Long term outcomes in octogenarians undergoing percutaneous coronary intervention: comparison of bare metal versus
Shanmugam Uthamalingam1, Imad Ahmado2, Vijairam Selvaraj3
1Division of Cardiology, Baystate Medical Center, Springfield, MA, United States.
Insights
In octogenarians, drug-eluting stents (DES) showed better outcomes than bare metal stents (BMS) after one year. DES reduced major adverse cardiac events (MACE) and target vessel revascularization (TVR) in patients over 80 undergoing percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Octogenarians are underrepresented in percutaneous coronary intervention (PCI) trials.
- Choosing the optimal stent type for patients over 80 is challenging.
- This study compares drug-eluting stents (DES) and bare metal stents (BMS) in this population.
Purpose of the Study:
- To compare the one-year outcomes of DES versus BMS in octogenarian patients undergoing PCI.
- To evaluate the safety and efficacy of different stent types in elderly patients.
Main Methods:
- Retrospective study of 320 consecutive patients (age >80) undergoing PCI.
- Comparison of outcomes between BMS (n=218) and DES (n=102) groups.
- One-year major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and target vessel revascularization (TVR) were analyzed using Cox regression.
Main Results:
- Higher one-year MACE incidence in the BMS group (18.8%) compared to DES (9.8%).
- Increased TVR in the BMS group (10.0% vs 3.9%).
- Diabetes mellitus was an independent predictor of increased MACE.
Conclusions:
- Octogenarians treated with BMS had a significantly higher risk of MACE and TVR compared to those treated with DES at one year.
- DES are recommended over BMS for octogenarians based on current PCI guidelines and study findings.
Background:
Octogenarians have been under-represented in percutaneous coronary intervention (PCI) trials, thus making difficult to choose the best type of stent in this patient population. We compared the outcomes of drug eluting (DES) and bare metal stent (BMS) at one year after implantation in this special population.
Methods:
A total of 320 consecutive patients over 80 years undergoing PCI with BMS (n=218) or DES (n=102) were retrospectively studied. One year major adverse cardiac events (MACEs) defined as cardiac death, non-fatal myocardial infarction and target vessel revascularization (TVR) were compared between the two groups. Cox regression analysis was used for data analysis.
Results:
The one year incidence of MACE was higher in the BMS group (18.8% vs 9.8%, adjusted hazard ratio [HR] 2.33; 95% confidence interval [C.I.]: 1.12 to 4.86 p=0.02). Diabetes mellitus was an independent predictor for increased MACE (adjusted HR: 1.99; C.I. 1.06 to 3.77, p=0.03). One year incidence of TVR was higher in the BMS group (10.0% vs 3.9% adjusted HR: 2.94; C.I. 1.01 to 8.59 p=0.045). There was no difference in cardiac death between the two groups.
Conclusion:
During one year follow-up, octogenarians treated with BMS had an increased risk of MACE compared with those treated with DES. DES should be preferred in indications recognized from current PCI guidelines.
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