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Drug coated balloon angioplasty in elderly patients with small vessel coronary disease
Dasdo A Sinaga1, Hee Hwa Ho2, Uwe Zeymer3
1Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore lukas_dasdo@yahoo.com.
Insights
Drug-coated balloon angioplasty (DCBA) is a safe and effective treatment for elderly patients with small vessel coronary disease (SVCD). Outcomes were comparable to younger patients, despite higher comorbidity rates in the older group.
Area of Science:
- Interventional Cardiology
- Geriatric Cardiology
- Vascular Medicine
Background:
- Coronary angioplasty in elderly patients presents increased risks due to comorbidities.
- Drug-coated balloon angioplasty (DCBA) offers an alternative for small vessel coronary disease (SVCD), potentially reducing dual antiplatelet therapy duration.
- This study investigates DCBA efficacy specifically in an elderly SVCD population.
Purpose of the Study:
- To assess the safety and efficacy of DCBA in elderly patients (≥75 years) with SVCD.
- To compare outcomes between elderly and younger patients undergoing DCBA for SVCD.
Main Methods:
- Prospective analysis of 447 patients from the SeQuent Please registry.
- Patients categorized into younger (<75 years) and older (≥75 years) age groups.
- Comparison of baseline characteristics, procedural outcomes, and major adverse cardiac events (MACE) at 30 days and 9 months.
Main Results:
- The older group exhibited higher rates of hypertension, renal insufficiency, atrial fibrillation, and calcified lesions.
- No MACE were observed in the older group at 30 days.
- At 9 months, MACE rates were similar between groups (4.2% younger vs. 6.1% older; p=0.453), with comparable target lesion revascularization rates (3.9% younger vs. 3.0% older; p=0.704). No cardiac deaths occurred.
Conclusions:
- DCBA demonstrates comparable safety and efficacy in elderly patients with SVCD compared to younger individuals.
- The procedure is effective despite the increased prevalence of comorbidities and complex coronary anatomy in the elderly population.
Background:
Coronary angioplasty in advanced age is associated with higher rate of comorbidities and complications. Drug coated balloon only angioplasty (DCBA) has emerged as an alternative to treat small vessel coronary disease (SVCD), of reference vessel diameters <2.8 mm, with shorter duration of dual antiplatelet (DAPT). This is the first study to assess the DCBA efficacy in an elderly population with SVCD.
Methods And Results:
We performed a prospective study of 447 patients (334 patients aged <75 and 113 patients aged ⩾75 years old) acquired from the SeQuent Please Small Vessel 'Paclitaxel-Coated Balloon Only' registry. In the older age group, more patients have hypertension (89% versus 77%; p = 0.006), renal insufficiency (21% versus 6%; p < 0.001), atrial fibrillation (17% versus 7%; p = 0.001), and calcified lesions (33% versus 20%; p = 0.006). At 30 days, there was one myocardial infarction requiring target lesion revascularization (TLR) in the younger group. No major adverse cardiac event (MACE) was observed in the older group. At 9 months, the MACE rate in the younger group was 4.2% and 6.1% in the older group (p = 0.453), with TLR rates at 3.9% and 3.0% (p = 0.704) respectively. There was no cardiac death observed.
Conclusion:
DBCA in the elderly with SVCD is as safe and effective compared with younger patients despite more complex anatomy and comorbidities.
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