title: Everolimus-eluting stent versus bare-metal stent in elderly (≥75 years) versus non-elderly (<75 years) patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: insights from the examination trial.
abstract: BACKGROUND
  The elderly (≥75years) constitute a high-risk subset of patients who continue to have a poorer prognosis than non-elderly (<75years). Whether the effects of everolimus-eluting stent (EES) in ST-segment elevation myocardial infarction (STEMI) are independent of age has not been reported. We investigated the outcomes following primary PCI (PPCI) with bare-metal stent (BMS) or EES in elderly vs. non-elderly STEMI patients.
  
  
  METHODS
  The EXAMINATION trial randomized 1498 STEMI patients to BMS or EES. The primary patient-oriented endpoint (POCE) was the combined of all-cause death, any-recurrent myocardial infarction (MI) and any-revascularization at 1-year. The secondary endpoint included the device-oriented combined (DOCE) of cardiac death, target-vessel MI and target-lesion revascularization. These endpoints and their components were compared between elderly and non-elderly.
  
  
  RESULTS
  Among patients enrolled in the trial, 245 (16.3%) were elderly, allocated to BMS (n=132) or EES (n=113), while the remaining 1253 (83.7%) were non-elderly, allocated to BMS (n=615) or EES (n=638). At 1-year, both the POCE and DOCE were observed more frequently in elderly vs. non-elderly group (24.5% vs. 10.5%, p<0.001 and 15.9% vs. 5.1%, p<0.001). Whereas in non-elderly, both POCE and DOCE were lower in EES vs. BMS (12.4% vs. 8.8%, p=0.03 and 6.7% vs. 3.6%, p=0.01), no differences were found in elderly, with a tendency for interaction between age and stent type for POCE (p=0.05). On multivariate analysis age ≥75 years was an independent predictor of POCE (HR 2.19 [95%CI 1.59-3.01], p<0.0001) and DOCE (HR 2.42 [95%CI 1.60-3.7], p<0.001) at 1-year.
  
  
  CONCLUSIONS
  In STEMI patients undergoing PPCI, advanced age (≥75 years) is associated with worse outcomes. The beneficial effects of EES over BMS tended to be age-dependent.
authors.affiliation: Hospital "Bolognini" Seriate, Bergamo, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ielasi
authors.affiliation: University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.affiliation: Hospital "Bolognini" Seriate, Bergamo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Silvestro
authors.affiliation: Heart Institute, University Hospital of Bellvitge, Barcelona, Spain; University Hospital of Bellvitge (IDIBELL), Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.affiliation: Hospital do Meixoeiro, Vigo, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Iñiguez
authors.affiliation: University Hospital of Sant Pau, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.affiliation: University Hospital San Carlos, Madrid, Spain.
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernandez-Antolin
authors.affiliation: Hospital General of Alicante, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Mainar
authors.affiliation: University Hospital Ferrara, Ferrara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: Amphia Ziekenhuis, Breda, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: den Heijer
authors.affiliation: Hospital Son Dureta, Palma de Mallorca, Spain.
authors.forename: Armando
authors.initials: A
authors.lastname: Bethencourt
authors.affiliation: Hospital Juan Canalejo, A Coruña, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Vazquez
authors.affiliation: Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Serruys
authors.affiliation: University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Sabate
authors.affiliation: Hospital "Bolognini" Seriate, Bergamo, Italy. Electronic address: tespili@katamail.com.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Tespili
mesh_terms: D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus
keywords: Drug-eluting stent; Elderly; Myocardial infarction; Outcome