Second-generation drug-eluting stents in the elderly patients with acute coronary syndrome: the in-hospital and 12-month follow-up of the all-comer registry.
BACKGROUND
Katowice-Zabrze registry provides data that can be used to evaluate clinical outcomes of percutaneous coronary interventions in elderly patients (≥70 y/o) treated with either first- (DES-I) or second-generation (DES-II) drug-eluting stents (DES).


METHODS
The registry consisted of data from 1916 patients treated with coronary interventions using either DES-I or DES-II stents. For our study, we defined patients ≥70 years of age as elderly. We evaluated any major adverse cardiac and cerebral events (MACCE) at 12-month follow-up.


RESULTS
Coronary angiography revealed a higher incidence of multivessel coronary artery disease in this elderly patient population. There were no differences in acute and subacute stent thrombosis (0.4 vs. 0.6%, p = 0.760; 0.4 vs. 0.4%; p = 0.712). Elderly patients experienced more in-hospital bleeding complications requiring blood transfusion (2.0 vs. 0.9%; p = 0.003). Resuscitated cardiac arrests (2.0 vs. 0.9%; p = 0.084) were observed more often in this elderly patients during hospitalization. The composite in-hospital MACCE rates did not differ statistically between both groups (1.4 vs. 1.1%; p = 0.567). Data from a twelve-month follow-up disclosed that mortality was higher (7.1 vs. 1.8%; p < 0.001) in the elderly, with no difference in TVR (7.2 vs. 9.9%, p = 0.075), MI (6.0 vs. 4.8%, p = 0.300), stroke (0.8 vs. 0.6%, p = 0.600) and composite MACCE (15.0 vs. 13.4%, p = 0.324). The age of 70 years or over was an independent predictor of death [HR = 2.55 (95% CI 1.49-4.37); p < 0.001]. The use of DES-II reduced the risk of MI [HR = 0.40 (95% CI 0.19-0.82); p = 0.012] in the elderly.


CONCLUSIONS
This elderly patient population had an increased risk of in-hospital bleeding complications requiring blood transfusion and a higher risk of death at 12-month follow-up. The use of new-generation DES reduced the risk of MI in the elderly population.
Third Division of Cardiology, Medical University of Silesia, Katowice, Poland. wojciech.wanha@gmail.com.
Wojciech
W
Wańha
Second Division of Cardiology, Medical University of Silesia, Zabrze, Poland.
Damian
D
Kawecki
Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Tomasz
T
Roleder
Second Division of Cardiology, Medical University of Silesia, Zabrze, Poland.
Beata
B
Morawiec
Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Sylwia
S
Gładysz
Division of Cardiothoracic Surgery, Medical University of Silesia, Katowice, Poland.
Adam
A
Kowalówka
Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Tomasz
T
Jadczyk
Division of Cardiology, Specialist Hospital, Wilkowice, Poland.
Barbara
B
Adamus
Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Tomasz
T
Pawłowski
Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Grzegorz
G
Smolka
Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Maciej
M
Kaźmierski
Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Andrzej
A
Ochała
Second Division of Cardiology, Medical University of Silesia, Zabrze, Poland.
Ewa
E
Nowalany-Kozielska
Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Wojciech
W
Wojakowski
D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D012042:Registries; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013927:Thrombosis / Q000453:epidemiology; D016896:Treatment Outcome
Drug-eluting stents; Elderly patients; Percutaneous coronary intervention