Percutaneous Coronary Intervention and Drug-Eluting Stent Use Among Patients ≥85 Years of Age in the United States
What is the comparative effectiveness of drug-eluting stents (DES) versus bare-metal stents (BMS) among patients ≥85 years of age?
The investigators examined 471,006 percutaneous coronary intervention (PCI) patients, ages ≥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. For adjusted analyses comparing DES with BMS, a propensity score model was created within each age group comparing DES versus BMS, and conditioned on 96 covariates obtained from linked clinical and claims data.
Patients ages ≥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], 0.77-0.83); age 75-84 years, 17% versus 25% (HR, 0.77; 95% CI, 0.75-0.79); and age 65-74 years, 10% versus 16% (HR, 0.73; 95% CI, 0.71-0.75). However, the adjusted mortality difference narrowed with increasing age (pinteraction < 0.001). In contrast, the adjusted HR for myocardial infarction (MI) rehospitalization associated with DES use was significantly lower with increasing age: age ≥85 years, 9% versus 12% (HR, 0.77; 95% CI, 0.71-0.83); age 75-84 years, 7% versus 9% (HR, 0.81; 95% CI, 0.77-0.84); and age 65-74 years, 7% versus 8% (HR, 0.84; 95% CI, 0.80-0.88) (pinteraction < 0.001).
The authors concluded that declines in DES use were most pronounced among those ages ≥85 years, yet lower adverse event rates associated with DES versus BMS use were observed.
This study suggests that among older patients, an increasing proportion of PCIs are performed in those ≥85 years of age, and compared with BMS use, DES use was associated with lower mortality and MI risks across all older age groups. However, it should be noted that in contrast to previous studies, DES use was not associated with lower repeat revascularization risk among older adults. These results call for additional studies to compare the effectiveness and safety of PCI treatments among elderly patients, focusing on endpoints relevant to this population, such as quality of life.
Keywords: Incidence, Myocardial Infarction, Follow-Up Studies, Coronary Restenosis, Coronary Angiography, Drug-Eluting Stents, Cardiovascular Diseases, Angioplasty, Balloon, Coronary, DNA Transposable Elements, United States, Percutaneous Coronary Intervention
< Back to Listings