Short- and long-term outcomes in octogenarians undergoing percutaneous coronary intervention with stenting.
OBJECTIVE
To investigate the incidence of cardiac events in octogenarians who underwent percutaneous coronary intervention (PCI) with stenting, as well as to evaluate the efficacy and safety of drug-eluting stents (DES) in this population.


RESULTS
The study included 6,129 consecutive patients who underwent PCI with stenting from 2000 to 2005 in our centre, of whom 291 (4.7%) were octogenarians. After adjusting for confounders, age ≥80 years appeared a significant predictor of high mortality at 30 days (adjusted hazard ratio [aHR] 1.92, 95% CI 1.23-3.01), and four years (aHR 2.25, 95% CI 1.77-2.85). No differences were seen with respect to incident myocardial infarction (MI), but target lesion (63.2 vs. 32.6 per 1,000 person-years at one year and 27.9 vs. 16.6 per 1,000 person-years at four years) and vessel (83.1 vs. 52.9 per 1,000 person-years at one year and 37.7 vs. 25.0 per 1,000 person-years at four years) revascularisation rates were lower in octogenarians. When comparing DES with bare metal stents (BMS) in octogenarians, mortality and MI rates were comparable, but there was a significantly lower incidence of target lesion revascularisation at one- (9.5 vs. 0.6 per 1,000 person-years, aHR 0.07, 95% CI 0.01-0.57) and four-year (3.4 vs. 0.7 per 1,000 person-years, aHR 0.16, 95% CI 0.04-0.59) follow-up in patients who received a DES.


CONCLUSIONS
Octogenarians undergoing PCI with stenting have an increased mortality risk, whereas the rates of repeat revascularisation in octogenarians are lower. This study suggests that the benefit of DES in reducing revascularisation rates is extended to elderly patients.
Department of Cardiology, Erasmus MC, ’s Gravendijkwal 230, Rotterdam, The Netherlands.
Milena Soriano
MS
Marcolino
Cihan
C
Simsek
Sanneke P M
SP
de Boer
Ron T
RT
van Domburg
Robert-Jan
RJ
van Geuns
Peter
P
de Jaegere
K Martijn
KM
Akkerhuis
Joost
J
Daemen
Patrick W
PW
Serruys
Eric
E
Boersma
D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017239:Paclitaxel / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use; D015607:Stents / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel; D020123:Sirolimus