title: Clinical effectiveness of coronary stents in elderly persons: results from 262,700 Medicare patients in the American College of Cardiology-National Cardiovascular Data Registry.
abstract: 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.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA. pamela.douglas@duke.edu
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Brennan
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenstein
authors.forename: Ghazala
authors.initials: G
authors.lastname: Haque
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.forename: David F
authors.initials: DF
authors.lastname: Kong
authors.forename: Bradley
authors.initials: B
authors.lastname: Hammill
authors.forename: Lesley
authors.initials: L
authors.lastname: Curtis
authors.forename: David
authors.initials: D
authors.lastname: Matchar
authors.forename: Ralph
authors.initials: R
authors.lastname: Brindis
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: 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