title: Drug-eluting stents in the elderly: long-term (> one year) clinical outcomes of octogenarians in the DESIRE (Drug-Eluting Stents In the REal world) registry.
abstract: BACKGROUND
  Despite the increasing number of elderly people, this high-complexity subset of patients is often excluded from randomized trials of percutaneous coronary intervention (PCI) and, therefore, limited data are available about their outcomes after drug-eluting stent (DES) implantation. We sought to compare the very long-term (> 1 year) clinical follow up of octogenarians treated with DES compared to younger individuals.
  
  
  METHODS
  The DESIRE registry is a prospective, nonrandomized, single-center registry with consecutive patients treated solely with DES between May 2002 and May 2007. The only exclusion criteria were the treatment of patients in the setting of acute myocardial infarction (MI) (< 72 hours) and lesions located in non-native coronary arteries. The primary endpoint was the occurrence of combined major adverse cardiac events (MACE) (cardiac death, non-fatal MI and target vessel revascularization) in-hospital and in very long term (> 1 year) follow up. Patients were clinically evaluated at 1, 3 and 6 months and then annually up to 5 years. Stent thrombosis was classified according to the ARC definition.
  
  
  RESULTS
  A total of 1,364 patients matched the inclusion/exclusion criteria and were sorted into 3 groups according to their ages: Group I = patients < 70 years of age (n = 914); Group II = patients greater than or equal to 70 and < 80 years of age (n = 334); and Group III = patients greater than or equal to 80 years old (n = 116). As expected, octogenarians had significantly more comorbid and complex anatomic lesion presentation. Nevertheless, in-hospital success was comparable among the 3 groups. Long-term (2.6 +/- 1.2 years) follow up was obtained from 97% of the total population and showed equivalent cumulative MACE in all age ranges (7.6% for < 70 years old vs. 5.4% for septuagenarians and 6.0% for octogenarians, p = 0.7). However, octogenarians had markedly more cardiac death, reflecting the severity of their comorbidity and the natural evolution of coronary disease. Of note, very few cases of stent thrombosis were noticed in the overall population (20 patients, 1.5%), with no difference among the groups.
  
  
  CONCLUSIONS
  PCI with DES represents an efficient and safe approach to treat coronary artery disease in the elderly, with low rates of combined MACE comparable to other age ranges.
authors.affiliation: Hospital do Coração - Associação do Sanatório Sírio, São Paulo, Brazil.
authors.forename: J Ribamar
authors.initials: JR
authors.lastname: Costa
authors.forename: Amanda
authors.initials: A
authors.lastname: Sousa
authors.forename: Adriana Costa
authors.initials: AC
authors.lastname: Moreira
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Costa
authors.forename: Galo
authors.initials: G
authors.lastname: Maldonado
authors.forename: Manuel N
authors.initials: MN
authors.lastname: Cano
authors.forename: Enilton T
authors.initials: ET
authors.lastname: Egito
authors.forename: Edson R
authors.initials: ER
authors.lastname: Romano
authors.forename: Marcos
authors.initials: M
authors.lastname: Barbosa
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pavanello
authors.forename: César
authors.initials: C
authors.lastname: Jardim
authors.forename: Abrão
authors.initials: A
authors.lastname: Cury
authors.forename: Otávio
authors.initials: O
authors.lastname: Berwanger
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Sousa
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D023921:Coronary Stenosis / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000628:therapy*; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents