title: Improved outcomes of elderly patients treated with drug-eluting versus bare metal stents in large coronary arteries: results from the BAsel Stent Kosten-Effektivitäts Trial PROspective Validation Examination randomized trial.
abstract: BACKGROUND
  Drug-eluting stents (DES) improve outcomes in elderly patients with small coronary artery disease compared with bare-metal stents (BMS), but randomized data in elderly patients in need of large coronary stents are not available.
  
  
  METHODS
  Planned secondary analysis of patients ≥75 years recruited to the "BASKET-PROVE" trial, in which 2,314 patients undergoing percutaneous coronary intervention for large (≥3.0 mm) native vessel disease were randomized 2:1 to DES (everolimus- vs sirolimus-eluting stents 1:1) versus BMS. All patients received 12 months of dual antiplatelet therapy. The primary end point was a composite of cardiac death or nonfatal myocardial infarction at 2 years.
  
  
  RESULTS
  Comparison of DES versus BMS among 405 patients ≥75 years showed significantly lower rates of the primary end point for DES (5.0% vs 11.6%; hazard ration (HR) 0.64 [0.44-0.91]; P = .014). Rates of nonfatal myocardial infarction (1.2% vs 5.5%, hazard ration (HR) 0.44 [0.21-0.83]; P = .009), all-cause death (7.4% vs 14.4%; HR 0.7 [0.51-0.95]; P = .02), and target vessel revascularization (TVR) (2.3% vs 6.2%; HR 0.59 [0.34-0.99]; P = .046) were also lower, whereas stent thrombosis and bleeding rates were similar. In contrast, among patients <75 years (n = 1,909), the only significant benefit of DES was a reduced rate of TVR (4.0% vs 8.7%, HR 0.66 [0.55-0.80]; P < .0001).
  
  
  CONCLUSIONS
  In patients ≥75 years requiring large (≥3.0 mm) coronary stents, use of DES was beneficial compared with BMS and reduced the rate of ischemic events, mortality, and TVR. These data suggest that DES should be preferred over BMS in elderly patients.
authors.affiliation: Cardiology, Triemli Hospital, Zurich, Switzerland. Electronic address: david.kurz@triemli.zuerich.ch.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kurz
authors.affiliation: Cardiology, Triemli Hospital, Zurich, Switzerland.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Bernheim
authors.affiliation: Cardiology, Triemli Hospital, Zurich, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Tüller
authors.affiliation: Cardiology, Triemli Hospital, Zurich, Switzerland.
authors.forename: Rainer
authors.initials: R
authors.lastname: Zbinden
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Raban
authors.initials: R
authors.lastname: Jeger
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kaiser
authors.affiliation: Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Soeren
authors.initials: S
authors.lastname: Galatius
authors.affiliation: Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Kim W
authors.initials: KW
authors.lastname: Hansen
authors.affiliation: Cardiology, University Hospital, Innsbruck, Austria.
authors.forename: Hannes
authors.initials: H
authors.lastname: Alber
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Pfisterer
authors.affiliation: Cardiology, Triemli Hospital, Zurich, Switzerland.
authors.forename: Franz R
authors.initials: FR
authors.lastname: Eberli
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D005060:Europe / Q000453:epidemiology; D000068338:Everolimus / Q000494:pharmacology*; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D011474:Prosthesis Design; D020123:Sirolimus / Q000494:pharmacology*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus