Safety and effectiveness of drug-eluting stents versus bare-metal stents in elderly patients with small coronary vessel disease

Etienne Puymirat, Fabio Mangiacapra, Aaron Peace, Yiannis Ntarladimas, Micaela Conte, Jozef Bartunek, Marc Vanderheyden, William Wijns, Bernard de Bruyne, Emanuele Barbato
Archives of Cardiovascular Diseases 2013, 106 (11): 554-61

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.

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