Safety and effectiveness of drug-eluting stents versus bare-metal stents in elderly patients with small coronary vessel disease.
BACKGROUND
Drug-eluting stents (DES) are more effective than bare-metal stents (BMS) in small coronary vessel disease. Whether this is true in elderly patients, it is unclear, as frailty and a high rate of comorbidities could increase the rate of DES-related complications.


OBJECTIVE
To assess procedural and long-term clinical outcomes of elderly patients with small vessel disease treated with DES or BMS.


METHODS
Consecutive elderly patients (≥ 75 years old) treated with stenting of native small coronary arteries (reference vessel diameter and implanted stent<3mm) were recruited during 2004-2008. Procedural and long-term clinical outcomes were compared between patients treated with BMS and DES. Propensity score-adjusted logistic regression analysis was performed to account for potential selection bias.


RESULTS
Among 293 patients (175 BMS, 118 DES), peri-procedural myocardial infarction (12 [7%] vs. 5 [4%]; P=0.35) and blood transfusions (3 [2%] vs. 0; P=0.08) were not significantly different between the BMS and DES groups. Clinical follow-up (96% of patients, median [interquartile range] follow-up 3.5 [2.4] years) showed significantly lower adjusted major adverse cardiac events (hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.24-0.72; P=0.002) and target vessel revascularization (TVR) (HR 0.33, 95% CI 0.14-0.76; P=0.009) in the DES group. No significant differences were observed between the groups in terms of death, myocardial infarction, stent thrombosis or bleeding.


CONCLUSIONS
In this retrospective, non-randomized analysis of the treatment of small vessel disease in elderly patients, DES were as safe and more effective than BMS with a significant reduction in TVR.
Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of cardiology, European Hospital Georges Pompidou, Assistance publique des Hôpitaux de Paris (AP-HP) and Inserm U 970, Paris Descartes University, Paris, France. Electronic address: etiennepuymirat@yahoo.fr.
Etienne
E
Puymirat
Fabio
F
Mangiacapra
Aaron
A
Peace
Yiannis
Y
Ntarladimas
Micaela
M
Conte
Jozef
J
Bartunek
Marc
M
Vanderheyden
William
W
Wijns
Bernard
B
de Bruyne
Emanuele
E
Barbato
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002858:Chromium Alloys; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D002858:Chromium Alloys
Angioplastie coronaire percutanée; BMS; Bare-metal stents; DAPT; DES; Drug-eluting stents; Elderly patients; IQR; MACE; MLD; PCI; Patients âgés; Percutaneous coronary intervention; Petits vaisseaux; SD; Small vessel disease; Stent actif; Stent non actif; TVR; bare-metal stents; drug-eluting stents; dual antiplatelet therapy; interquartile range; major adverse cardiac events; minimal lumen diameter; percutaneous coronary intervention; standard deviation; target vessel revascularization