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Safety and effectiveness of drug-eluting stents versus bare-metal stents in elderly patients with small coronary vessel disease.
Arch Cardiovasc Dis. 2013 Nov; 106(11):554-61.AC

Abstract

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.

AIMS

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.

Authors+Show Affiliations

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.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24231052

Citation

Puymirat, Etienne, et al. "Safety and Effectiveness of Drug-eluting Stents Versus Bare-metal Stents in Elderly Patients With Small Coronary Vessel Disease." Archives of Cardiovascular Diseases, vol. 106, no. 11, 2013, pp. 554-61.
Puymirat E, Mangiacapra F, Peace A, et al. Safety and effectiveness of drug-eluting stents versus bare-metal stents in elderly patients with small coronary vessel disease. Arch Cardiovasc Dis. 2013;106(11):554-61.
Puymirat, E., Mangiacapra, F., Peace, A., Ntarladimas, Y., Conte, M., Bartunek, J., Vanderheyden, M., Wijns, W., de Bruyne, B., & Barbato, E. (2013). Safety and effectiveness of drug-eluting stents versus bare-metal stents in elderly patients with small coronary vessel disease. Archives of Cardiovascular Diseases, 106(11), 554-61. https://doi.org/10.1016/j.acvd.2013.06.056
Puymirat E, et al. Safety and Effectiveness of Drug-eluting Stents Versus Bare-metal Stents in Elderly Patients With Small Coronary Vessel Disease. Arch Cardiovasc Dis. 2013;106(11):554-61. PubMed PMID: 24231052.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and effectiveness of drug-eluting stents versus bare-metal stents in elderly patients with small coronary vessel disease. AU - Puymirat,Etienne, AU - Mangiacapra,Fabio, AU - Peace,Aaron, AU - Ntarladimas,Yiannis, AU - Conte,Micaela, AU - Bartunek,Jozef, AU - Vanderheyden,Marc, AU - Wijns,William, AU - de Bruyne,Bernard, AU - Barbato,Emanuele, Y1 - 2013/11/11/ PY - 2013/05/01/received PY - 2013/06/23/revised PY - 2013/06/25/accepted PY - 2013/11/16/entrez PY - 2013/11/16/pubmed PY - 2014/7/22/medline KW - Angioplastie coronaire percutanée KW - BMS KW - Bare-metal stents KW - DAPT KW - DES KW - Drug-eluting stents KW - Elderly patients KW - IQR KW - MACE KW - MLD KW - PCI KW - Patients âgés KW - Percutaneous coronary intervention KW - Petits vaisseaux KW - SD KW - Small vessel disease KW - Stent actif KW - Stent non actif KW - TVR KW - bare-metal stents KW - drug-eluting stents KW - dual antiplatelet therapy KW - interquartile range KW - major adverse cardiac events KW - minimal lumen diameter KW - percutaneous coronary intervention KW - standard deviation KW - target vessel revascularization SP - 554 EP - 61 JF - Archives of cardiovascular diseases JO - Arch Cardiovasc Dis VL - 106 IS - 11 N2 - 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. AIMS: 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. SN - 1875-2128 UR - https://www.unboundmedicine.com/medline/citation/24231052/Safety_and_effectiveness_of_drug_eluting_stents_versus_bare_metal_stents_in_elderly_patients_with_small_coronary_vessel_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1875-2136(13)00302-1 DB - PRIME DP - Unbound Medicine ER -