Drug-eluting stents in octogenarians: Early and intermediate outcome

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.