title: Impact of age on long-term outcome after primary angioplasty with bare-metal or drug-eluting stent (from the DESERT cooperation).
abstract: Despite mechanical reperfusion, elderly patients with ST-segment elevation myocardial infarction (STEMI) still experience unsatisfactory outcomes. Drug-eluting stents (DES) have significantly reduced target-vessel revascularization (TVR), but concerns have emerged about the higher risk of late stent thrombosis, which may be more pronounced in elderly patients. Therefore, the aim of this study was to evaluate the impact of age on outcome in patients with STEMI who underwent primary angioplasty with bare-metal stents (BMS) or DES. Our population comprised 6,298 patients who underwent primary angioplasty and stent implantation included in the Drug-Eluting Stent in Primary Angioplasty (DESERT) Cooperation database. Age was significantly associated with female gender (p <0.001), diabetes (p <0.001), hypertension (p <0.001), previous myocardial infarction (MI; p <0.001), ischemia time (p <0.001), and anterior MI (p <0.001) but inversely related to smoking (p <0.001). Elderly patients most often had infarct-related artery located in the descending artery (p = 0.014) and impaired postprocedural thrombolysis in myocardial infarction flow (p <0.001). Elderly patients were less often on clopidogrel at follow-up. At long-term follow-up, age was associated with a higher rate of death (hazard ratio [95% confidence interval] = 2.17 [1.97 to 2.39], p <0.0001), whereas no impact was observed on reinfarction (p = 0.36), stent thrombosis (p = 0.84), and TVR (p = 0.54). These results were confirmed in patients receiving both BMS and DES. The impact of age on mortality was confirmed after correction for baseline confounding factors (gender, diabetes hypertension, hypercholesterolemia, smoking, ischemia time, anterior MI, infarct-related artery location, and postprocedural thrombolysis in myocardial infarction 3 flow; adjusted hazard ratio [95% confidence interval] = 2.13 [1.78 to 2.56], p <0.001). In conclusion, this study shows that in patients with STEMI who underwent primary angioplasty, age is independently associated with higher mortality, observed with both BMS and DES, whereas no impact was observed on the rate of reinfarction, stent thrombosis, and TVR.
authors.affiliation: Division of Cardiology, Ospedale Maggiore della Carità, Eastern Piedmont University, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: Maurits T
authors.initials: MT
authors.lastname: Dirksen
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Martin
authors.initials: M
authors.lastname: Schalij
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Bas
authors.initials: B
authors.lastname: van der Hoeven
authors.forename: Marteen A
authors.initials: MA
authors.lastname: Vink
authors.forename: Christoph
authors.initials: C
authors.lastname: Kaiser
authors.forename: Carmine
authors.initials: C
authors.lastname: Musto
authors.forename: Tania
authors.initials: T
authors.lastname: Chechi
authors.forename: Gaia
authors.initials: G
authors.lastname: Spaziani
authors.forename: Luis Salvador
authors.initials: LS
authors.lastname: Diaz de la Llera
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pasceri
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Lorenzo
authors.forename: Roberto
authors.initials: R
authors.lastname: Violini
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome