Clinical effectiveness of coronary stents in elderly persons: results from 262,700 Medicare patients in the American College of Cardiology-National Cardiovascular Data Registry.
OBJECTIVE
The aim of this study was to compare outcomes in older individuals receiving drug-eluting stents (DES) and bare-metal stents (BMS).


BACKGROUND
Comparative effectiveness of DES relative to BMS remains unclear.


METHODS
Outcomes were evaluated in 262,700 patients from 650 National Cardiovascular Data Registry sites during 2004 to 2006 with procedural registry data linked to Medicare claims for follow-up. Outcomes including death, myocardial infarction (MI), revascularization, major bleeding, stroke, death or MI, death or MI or revascularization, and death or MI or stroke were compared with estimated cumulative incidence rates with inverse probability weighted estimators and Cox proportional hazards ratios.


RESULTS
The DES were implanted in 217,675 patients and BMS were implanted in 45,025. At 30 months, DES patients had lower unadjusted rates of death (12.9% vs. 17.9%), MI (7.3 of 100 patients vs. 10.0 of 100 patients), and revascularization (23.0 of 100 patients vs. 24.5 of 100 patients) with no difference in stroke or bleeding. After adjustment, DES patients had lower rates of death (13.5% vs. 16.5%, hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.72 to 0.79, p < 0.001) and MI (7.5 of 100 patients vs. 8.9 of 100 patients, HR: 0.77, 95% CI: 0.72 to 0.81, p < 0.001), with minimal difference in revascularization (23.5 of 100 patients vs. 23.4 of 100 patients; HR: 0.91, 95% CI: 0.87 to 0.96), stroke (3.1 of 100 patients vs. 2.7 of 100 patients, HR: 0.97, 95% CI: 0.88 to 1.07), or bleeding (3.4 of 100 patients vs. 3.6 of 100 patients, HR: 0.91, 95% CI: 0.84 to 1.00). The DES survival benefit was observed in all subgroups analyzed and persisted throughout 30 months of follow-up.


CONCLUSIONS
In this largest ever real-world study, patients receiving DES had significantly better clinical outcomes than their BMS counterparts, without an associated increase in bleeding or stroke, throughout 30 months of follow-up and across all pre-specified subgroups.
Douglas
Pamela S
PS
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA. pamela.douglas@duke.edu
Brennan
J Matthew
JM
Anstrom
Kevin J
KJ
Sedrakyan
Art
A
Eisenstein
Eric L
EL
Haque
Ghazala
G
Dai
David
D
Kong
David F
DF
Hammill
Bradley
B
Curtis
Lesley
L
Matchar
David
D
Brindis
Ralph
R
Peterson
Eric D
ED
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D002318:Cardiovascular Diseases / Q000401:mortality / Q000628:therapy*; D016001:Confidence Intervals; D023903:Coronary Restenosis / Q000401:mortality / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000628:therapy; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D012955:Societies, Medical; D015607:Stents; D014481:United States / Q000453:epidemiology