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Research paper
Published online: 2019-11-06
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Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials

SungA Bae, Yongcheol Kim, Bill D. Gogas, Min Chul Kim, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Youngkeun Ahn, Myung Ho Jeong
DOI: 10.5603/CJ.a2019.0109
·
Pubmed: 31702046

open access

Ahead of print
Original articles
Published online: 2019-11-06

Abstract

Background: Current guidelines recommend newer generation drug-eluting stents (DES) over bare-metal stents (BMS) in patients with ischemic heart disease. However, there is no age-specific recommendation in elderly patients.

Methods:  Meta-analysis was performed of 6 randomized studies enrolling 5,042 elderly patients who underwent percutaneous coronary intervention (PCI) with stent implantation (DES, n = 2,579; BMS, n = 2,463).

Results: Combined data indicated a significant reduction in major adverse cardiovascular events (MACEs) with use of DES (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44–0.71, p < 0.001). Moreover, use of DES was associated with a significantly lower incidence of myocardial infarction (OR 0.54, 95% CI 0.36–0.81, p = 0.003) and repeat revascularization (OR 0.44, 95% CI 0.31–0.62, p < 0.001), was compared to that with the use of BMS. Stent thrombosis and bleeding complication rates were not significantly different between groups. In a subgroup meta-analysis, short duration (1 or 6 months) dual antiplatelet therapy (DAPT) was associated with a significantly lower MACE rate (OR 0.49, 95% CI 0.34–0.80; p = 0.003) in elderly patients who underwent PCI with everolimus-eluting stent (EES) implantation, compared with that using long duration DAPT.

Conclusions: This meta-analysis provides clinically relevant evidence that DES rather than BMS should be selected for elderly patients.

Abstract

Background: Current guidelines recommend newer generation drug-eluting stents (DES) over bare-metal stents (BMS) in patients with ischemic heart disease. However, there is no age-specific recommendation in elderly patients.

Methods:  Meta-analysis was performed of 6 randomized studies enrolling 5,042 elderly patients who underwent percutaneous coronary intervention (PCI) with stent implantation (DES, n = 2,579; BMS, n = 2,463).

Results: Combined data indicated a significant reduction in major adverse cardiovascular events (MACEs) with use of DES (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44–0.71, p < 0.001). Moreover, use of DES was associated with a significantly lower incidence of myocardial infarction (OR 0.54, 95% CI 0.36–0.81, p = 0.003) and repeat revascularization (OR 0.44, 95% CI 0.31–0.62, p < 0.001), was compared to that with the use of BMS. Stent thrombosis and bleeding complication rates were not significantly different between groups. In a subgroup meta-analysis, short duration (1 or 6 months) dual antiplatelet therapy (DAPT) was associated with a significantly lower MACE rate (OR 0.49, 95% CI 0.34–0.80; p = 0.003) in elderly patients who underwent PCI with everolimus-eluting stent (EES) implantation, compared with that using long duration DAPT.

Conclusions: This meta-analysis provides clinically relevant evidence that DES rather than BMS should be selected for elderly patients.

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Keywords

drug-eluting stent, bare-metal stent, elderly, clinical trials, clinical research

About this article
Title

Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Research paper

Published online

2019-11-06

DOI

10.5603/CJ.a2019.0109

Pubmed

31702046

Keywords

drug-eluting stent
bare-metal stent
elderly
clinical trials
clinical research

Authors

SungA Bae
Yongcheol Kim
Bill D. Gogas
Min Chul Kim
Doo Sun Sim
Young Joon Hong
Ju Han Kim
Youngkeun Ahn
Myung Ho Jeong

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