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

• Published in: Cardiology journal Vol. 28; no. 2; pp. 223 - 234
• Main Authors: Bae, SungA, Kim, Yongcheol, Gogas, Bill D, Kim, Min Chul, Sim, Doo Sun, Hong, Young Joon, Kim, Ju Han, Ahn, Youngkeun, Jeong, Myung Ho
• Format: Journal Article
• Language: English
• Published: Poland Wydawnictwo Via Medica 2021; Via Medica
• Subjects: Angioplasty; Bias; Cardiology; Cardiovascular disease; Clinical outcomes; Clinical trials; Consortia; Coronary vessels; Heart attacks; Interventional Cardiology; Meta-analysis; Stents; Thrombosis; Vein & artery diseases; bare-metal stent; clinical trials; drug-eluting stent; clinical research; elderly
• DOI: 10.5603/cj.a2019.0109
• ISSN: 1897-5593

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. 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). 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 everolimuseluting stent implantation, compared with that using long duration DAPT. This meta-analysis provides clinically relevant evidence that DES rather than BMS should be selected for elderly patients.