title: Long-term clinical outcome of elderly patients with acute coronary syndrome treated with early percutaneous coronary intervention: Insights from the BASE ACS randomized controlled trial: Bioactive versus everolimus-eluting stents in elderly patients.
abstract: BACKGROUND
  The BASE ACS trial demonstrated an outcome of titanium-nitride-oxide-coated bioactive stents (BAS) that was non-inferior to everolimus-eluting stents (EES) in patients presenting with acute coronary syndrome (ACS). We performed a post hoc analysis of elderly versus non-elderly patients from the BASE ACS trial.
  
  
  METHODS
  We randomized 827 patients (1:1) presenting with ACS to receive either BAS or EES. The primary endpoint was major adverse cardiac events (MACE): a composite of cardiac death, non-fatal myocardial infarction (MI), or ischemia-driven target lesion revascularization (TLR). Follow-up was planned at 12months and yearly thereafter for up to 7years. Elderly age was defined as ≥65years.
  
  
  RESULTS
  Of the 827 patients enrolled in the BASE ACS trial, 360 (43.5%) were elderly. Mean follow-up duration was 4.2±1.9years. MACE was more frequent in elderly versus younger patients (19.7% versus 12.0%, respectively, p=0.002), probably driven by more frequent cardiac death and non-fatal MI events (5.3% versus 1.5%, and 9.7% versus 4.5%, p=0.002 and p=0.003, respectively). The rates of ischemia-driven TLR were comparable (p>0.05). In propensity score-matched analysis (215 pairs), only cardiac death was more frequent in elderly patients (6% versus 1.4%, respectively, p=0.01). Diabetes independently predicted both MACE and cardiac death in elderly patients.
  
  
  CONCLUSIONS
  Elderly patients treated with stent implantation for ACS had worse long-term clinical outcome, compared with younger ones, mainly due to a higher death rate.
authors: Heart Center, Satakunta Central Hospital, Pori, Finland.
authors: Wail
authors: W
authors: Nammas
authors: Department of Cardiology, Brighton and Sussex University Hospital NHS Trust, Brighton, UK.
authors: Adam
authors: A
authors: de Belder
authors: Department of Internal Medicine, Division of Cardiology, University of Oulu, Oulu, Finland.
authors: Matti
authors: M
authors: Niemelä
authors: Department of Cardiology, Kokkola Central Hospital, Kokkola, Finland.
authors: Jussi
authors: J
authors: Sia
authors: Department of Internal Medicine, Division of Cardiology, University of Oulu, Oulu, Finland; Heart Centre, Kuopio University Hospital, Kuopio, Finland.
authors: Hannu
authors: H
authors: Romppanen
authors: Helsinki University Hospital, Helsinki, Finland.
authors: Mika
authors: M
authors: Laine
authors: Heart Center, Satakunta Central Hospital, Pori, Finland. Electronic address: pasi.karjalainen@satshp.fi.
authors: Pasi P
authors: PP
authors: Karjalainen
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001672:Biocompatible Materials; D002318:Cardiovascular Diseases / Q000401:mortality; D003920:Diabetes Mellitus / Q000453:epidemiology; D054855:Drug-Eluting Stents; D061345:Early Medical Intervention; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012008:Recurrence; D016037:Single-Blind Method; D015607:Stents; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D001672:Biocompatible Materials; C434243:titanium-nitride-oxide; D000068338:Everolimus; D014025:Titanium
keywords: Acute coronary syndrome; Elderly; Everolimus-eluting stents; Titanium–nitride–oxide-coated stents