Percutaneous Coronary Intervention and Drug-Eluting Stent Use Among Patients ≥85 Years of Age in the United States

• Published in: Journal of the American College of Cardiology Vol. 59; no. 2; pp. 105 - 112
• Main Authors: Wang, Tracy Y., MD, MHS, MSc, Masoudi, Frederick A., MD, MSPH, Messenger, John C., MD, Shunk, Kendrick A., MD, PhD, Boyle, Andrew, PhD, MBBS, Brennan, J. Matthew, MD, MPH, Anderson, H. Vernon, MD, Anstrom, Kevin J., PhD, Dai, David, PhD, Peterson, Eric D., MD, MPH, Douglas, Pamela S., MD, Rumsfeld, John S., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 10.01.2012; Elsevier; Elsevier Limited
• Subjects: Age Factors; Aged; Aged, 80 and over; aging; Angioplasty, Balloon, Coronary - statistics & numerical data; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; coronary artery disease; Diseases of the cardiovascular system; Drug therapy; Drug-Eluting Stents - statistics & numerical data; Drug-Eluting Stents - utilization; Female; Heart attacks; Humans; Internal Medicine; Male; Medical sciences; Mortality; myocardial infarction; Older people; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); stent; Stents; Treatment Outcome; United States; United States; North America; America; United States > US; coronary artery disease; stent; myocardial infarction; BMS; HR; drug-eluting stent(s); percutaneous coronary intervention; DES; PCI; hazard ratio; aging; MI; bare metal stent(s); Human; Atherectomy; Angioplasty; Coronary artery; Instrumentation therapy; Patient; Circulatory system; Cardiology; Drug eluting stent; Age; Percutaneous route
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2011.10.853

Objectives This study assessed the comparative effectiveness of drug-eluting stents (DES) versus bare-metal stents (BMS) among patients ≥85 years of age. Background Despite an aging population, little is known about the comparative effectiveness of DES versus BMS among patients age ≥85 years undergoing percutaneous coronary intervention (PCI). Methods We examined 471,006 PCI patients age ≥65 years at 947 hospitals in the National Cardiovascular Data Registry between 2004 and 2008 and linked to Medicare claims data. Long-term outcomes (median follow-up 640.8 ± 423.5 days) were compared between users of DES and BMS. Results Patients age ≥85 years comprise an increasing proportion of PCIs performed among elderly subjects, yet rates of DES use declined the most in this age group. Compared with BMS, use of DES was associated with lower mortality: age ≥85 years, 29% versus 38% (adjusted hazard ratio [HR]: 0.80 [95% confidence interval (CI): 0.77 to 0.83]); age 75 to 84 years, 17% versus 25% (HR: 0.77 [95% CI: 0.75 to 0.79]); and age 65 to 74 years, 10% versus 16% (HR: 0.73 [95% CI: 0.71 to 0.75]). However, the adjusted mortality difference narrowed with increasing age (pinteraction <0.001). In contrast, the adjusted HR for myocardial infarction rehospitalization associated with DES use was significantly lower with increasing age: age ≥85 years, 9% versus 12% (HR: 0.77 [95% CI: 0.71 to 0.83]); age 75 to 84 years, 7% versus 9% (HR: 0.81 [95% CI: 0.77 to 0.84]); and age 65 to 74 years, 7% versus 8% (HR: 0.84 [95% CI: 0.80 to 0.88]) (pinteraction <0.001). Conclusions In this national study of older patients undergoing PCI, declines in DES use were most pronounced among those aged ≥85 years, yet lower adverse-event rates associated with DES versus BMS use were observed.