SENIOR: DES vs. BMS in Elderly CAD Patients on Shortened DAPT

Percutaneous coronary intervention (PCI) with a contemporary drug-eluting stent (DES) is more effective and as safe as using bare-metal stents (BMS) in elderly patients with coronary artery disease who are on shortened dual antiplatelet therapy (DAPT) tailored to their clinical presentation, said researchers presenting on the SENIOR trial during TCT 2017 in Denver.

Researchers assigned 1,200 patients with coronary artery disease to either one month (stable presentation) or six months (unstable presentation) of DAPT. Patients were then randomized by computer to either DES (n=596) or a BMS (n=604). The primary endpoint was a composite of all-cause mortality, myocardial infarction, stroke or ischemia-driven target lesion revascularisation. Secondary endpoints included rate of bleeding and stent thrombosis between DES and BMS-treated patients at one year.

Among the results, the primary endpoint occurred in 68 patients (11.6 percent) in the DES group, compared to 98 patients (16.4 percent) in the BMS group (p=0.0172). Ischemia driven target-lesion revascularisation was also lower in the DES group, compared to the BMS group (10 patients/1.7 percent vs. 35 patients/5.9 percent, respectively). Bleeding complications and stent thrombosis rates were low in both groups, with no significant differences.

"Among elderly patients who undergo PCI, a DES and a short duration of DAPT is superior to BMS with respect to the occurrence of all-cause mortality, myocardial infarction, stroke and ischemia-driven target lesion revascularisation," researchers said. They also suggested BMS no longer be used as a strategy to reduce DAPT duration in these patients.


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