title: Comparative effectiveness of drug-eluting stents on long-term outcomes in elderly patients treated for in-stent restenosis: a report from the National Cardiovascular Data Registry.
abstract: OBJECTIVE
  We assessed the long-term outcomes of elderly patients who had in-stent restenosis (ISR) treated with drug-eluting stents (DES) compared with other treatment strategies.
  
  
  BACKGROUND
  Elderly patients with ISR represent a vulnerable group of which little is known regarding the safety and efficacy of repeat percutaneous coronary intervention (PCI).
  
  
  METHODS
  We analyzed patients ≥ 65 years of age who underwent PCI for ISR in the National Cardiovascular Data Registry(®) from 2004 to 2008. Death, myocardial infarction (MI), revascularization, stroke, and bleeding were assessed for up to 30 months by a linkage with Medicare rehospitalization claims.
  
  
  RESULTS
  Of 43,679 linked patients, 30,012 were treated with DES, 8,277 with balloon angioplasty (BA), and 4,917 with bare metal stents (BMS). Compared with BMS, DES use was associated with a lower propensity score-matched (PM) risk of death (hazard ratio [HR] 0.72; 95% confidence interval [CI] 0.66-0.80, P < 0.001), MI (HR 0.81; 95% CI 0.70-0.93, P = 0.003), and revascularization (HR 0.90; 95% CI 0.82-1.00, P = 0.055). Compared with BA, DES use was associated with a lower PM risk of death (HR 0.82; 95% CI 0.76-0.89, P < 0.001) and revascularization (HR 0.86; 95% CI 0.80-0.93, P < 0.001), but no statistically significant difference across other endpoints. There were no significant differences in long-term outcomes for BA compared with BMS.
  
  
  CONCLUSIONS
  There was lower mortality and reduced risk for MI, revascularization, and stroke, but a similar rate of bleeding with DES compared with other modalities. Our results indicate that DES use is a comparatively effective strategy to treat elderly patients with ISR.
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kutcher
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Brennan
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Nowwar
authors.initials: N
authors.lastname: Mustafa
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakayan
authors.forename: Michael E
authors.initials: ME
authors.lastname: Booth
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057186:Comparative Effectiveness Research; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057216:Propensity Score; D011474:Prosthesis Design; D012042:Registries; D019233:Retreatment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: elderly; long-term outcomes; percutaneous coronary intervention; restenosis