Drug-eluting stents in octogenarians: Early and intermediate outcome

Pieter J. Vlaar, Ryan J. Lennon, Charanjit Rihal, Mandeep Singh, Henry H. Ting, John F. Bresnahan, David Holmes

Research output: Contribution to journalArticle

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Abstract

Background: Large randomized controlled trials have demonstrated that percutaneous coronary intervention with the routine use of drug-eluting stents is safe and effective. However, octogenarians are usually excluded from these trials. Methods: We analyzed 2453 consecutive patients who underwent DES implantation at the Mayo Clinic (Rochester, MN). The patients were classified in 2 age groups: patients ≥80 years of age ≤79 years of age. Results: Patients ≥80 years old had significantly more adverse baseline characteristics including more comorbid conditions and more severe extensive coronary artery disease. Procedural success was high irrespective of the age group-97% in patients ≥80 years of age versus 98% in the younger patients. Multivariate analysis demonstrated that age of ≥80 years was significantly associated with inhospital major adverse cardiac events (MACEs) (P = .004). In addition, among inhospital survivors, octogenarians also had higher follow-up MACE rates (P < .001). At 12 months of follow-up, patients ≥80 years of age had a mortality of 8.9% versus 3.0% for the younger patients (P < .001). The older patients also had more recurrent myocardial infarction (5.2% vs 2.6%, P = .019). However, there was no significant difference in 12-month target lesion revascularization (4.5% vs 4.9% [≥80 years of age vs ≤79 years of age]) or coronary artery bypass grafting (1.8% vs 1.3% [≥80 years of age vs ≤ 79 years of age]). After age-sex adjustment, life expectancy of octogenarians was similar to that of the general population (P = .78). Conclusion: This study showed that drug-eluting stent implantation in octogenarians has high initial procedural success rates compared with the younger patients despite having more severe baseline risk characteristics. During follow-up, death and overall MACE rates remain higher in octogenarians but target lesion revascularization rates are similar.

Original languageEnglish (US)
Pages (from-to)680-686
Number of pages7
JournalAmerican Heart Journal
Volume155
Issue number4
DOIs
StatePublished - Apr 2008

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Drug-Eluting Stents
Age Groups
Percutaneous Coronary Intervention
Life Expectancy
Coronary Artery Bypass
Survivors
Coronary Artery Disease
Multivariate Analysis
Randomized Controlled Trials
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Vlaar, P. J., Lennon, R. J., Rihal, C., Singh, M., Ting, H. H., Bresnahan, J. F., & Holmes, D. (2008). Drug-eluting stents in octogenarians: Early and intermediate outcome. American Heart Journal, 155(4), 680-686. https://doi.org/10.1016/j.ahj.2007.11.007

Drug-eluting stents in octogenarians : Early and intermediate outcome. / Vlaar, Pieter J.; Lennon, Ryan J.; Rihal, Charanjit; Singh, Mandeep; Ting, Henry H.; Bresnahan, John F.; Holmes, David.

In: American Heart Journal, Vol. 155, No. 4, 04.2008, p. 680-686.

Research output: Contribution to journalArticle

Vlaar, PJ, Lennon, RJ, Rihal, C, Singh, M, Ting, HH, Bresnahan, JF & Holmes, D 2008, 'Drug-eluting stents in octogenarians: Early and intermediate outcome', American Heart Journal, vol. 155, no. 4, pp. 680-686. https://doi.org/10.1016/j.ahj.2007.11.007
Vlaar PJ, Lennon RJ, Rihal C, Singh M, Ting HH, Bresnahan JF et al. Drug-eluting stents in octogenarians: Early and intermediate outcome. American Heart Journal. 2008 Apr;155(4):680-686. https://doi.org/10.1016/j.ahj.2007.11.007
Vlaar, Pieter J. ; Lennon, Ryan J. ; Rihal, Charanjit ; Singh, Mandeep ; Ting, Henry H. ; Bresnahan, John F. ; Holmes, David. / Drug-eluting stents in octogenarians : Early and intermediate outcome. In: American Heart Journal. 2008 ; Vol. 155, No. 4. pp. 680-686.
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abstract = "Background: Large randomized controlled trials have demonstrated that percutaneous coronary intervention with the routine use of drug-eluting stents is safe and effective. However, octogenarians are usually excluded from these trials. Methods: We analyzed 2453 consecutive patients who underwent DES implantation at the Mayo Clinic (Rochester, MN). The patients were classified in 2 age groups: patients ≥80 years of age ≤79 years of age. Results: Patients ≥80 years old had significantly more adverse baseline characteristics including more comorbid conditions and more severe extensive coronary artery disease. Procedural success was high irrespective of the age group-97{\%} in patients ≥80 years of age versus 98{\%} in the younger patients. Multivariate analysis demonstrated that age of ≥80 years was significantly associated with inhospital major adverse cardiac events (MACEs) (P = .004). In addition, among inhospital survivors, octogenarians also had higher follow-up MACE rates (P < .001). At 12 months of follow-up, patients ≥80 years of age had a mortality of 8.9{\%} versus 3.0{\%} for the younger patients (P < .001). The older patients also had more recurrent myocardial infarction (5.2{\%} vs 2.6{\%}, P = .019). However, there was no significant difference in 12-month target lesion revascularization (4.5{\%} vs 4.9{\%} [≥80 years of age vs ≤79 years of age]) or coronary artery bypass grafting (1.8{\%} vs 1.3{\%} [≥80 years of age vs ≤ 79 years of age]). After age-sex adjustment, life expectancy of octogenarians was similar to that of the general population (P = .78). Conclusion: This study showed that drug-eluting stent implantation in octogenarians has high initial procedural success rates compared with the younger patients despite having more severe baseline risk characteristics. During follow-up, death and overall MACE rates remain higher in octogenarians but target lesion revascularization rates are similar.",
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AU - Rihal, Charanjit

AU - Singh, Mandeep

AU - Ting, Henry H.

AU - Bresnahan, John F.

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N2 - Background: Large randomized controlled trials have demonstrated that percutaneous coronary intervention with the routine use of drug-eluting stents is safe and effective. However, octogenarians are usually excluded from these trials. Methods: We analyzed 2453 consecutive patients who underwent DES implantation at the Mayo Clinic (Rochester, MN). The patients were classified in 2 age groups: patients ≥80 years of age ≤79 years of age. Results: Patients ≥80 years old had significantly more adverse baseline characteristics including more comorbid conditions and more severe extensive coronary artery disease. Procedural success was high irrespective of the age group-97% in patients ≥80 years of age versus 98% in the younger patients. Multivariate analysis demonstrated that age of ≥80 years was significantly associated with inhospital major adverse cardiac events (MACEs) (P = .004). In addition, among inhospital survivors, octogenarians also had higher follow-up MACE rates (P < .001). At 12 months of follow-up, patients ≥80 years of age had a mortality of 8.9% versus 3.0% for the younger patients (P < .001). The older patients also had more recurrent myocardial infarction (5.2% vs 2.6%, P = .019). However, there was no significant difference in 12-month target lesion revascularization (4.5% vs 4.9% [≥80 years of age vs ≤79 years of age]) or coronary artery bypass grafting (1.8% vs 1.3% [≥80 years of age vs ≤ 79 years of age]). After age-sex adjustment, life expectancy of octogenarians was similar to that of the general population (P = .78). Conclusion: This study showed that drug-eluting stent implantation in octogenarians has high initial procedural success rates compared with the younger patients despite having more severe baseline risk characteristics. During follow-up, death and overall MACE rates remain higher in octogenarians but target lesion revascularization rates are similar.

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