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

David J Kurz, Alain M Bernheim, David Tüller, Rainer Zbinden, Raban Jeger, Christoph Kaiser, Soeren Galatius, Kim W Hansen, Hannes Alber, Matthias Pfisterer, Franz R Eberli

12 Citations (Scopus)

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.

Original languageEnglish
JournalAmerican Heart Journal
Volume170
Issue number4
Pages (from-to)787-795.e1
ISSN0002-8703
DOIs
Publication statusPublished - Oct 2015

Keywords

  • Aged
  • Coronary Angiography
  • Coronary Artery Disease
  • Coronary Vessels
  • Drug-Eluting Stents
  • Europe
  • Everolimus
  • Follow-Up Studies
  • Humans
  • Immunosuppressive Agents
  • Middle Aged
  • Percutaneous Coronary Intervention
  • Prospective Studies
  • Prosthesis Design
  • Sirolimus
  • Survival Rate
  • Treatment Outcome

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this