TY - JOUR
T1 - Sirolimus-eluting coronary stents in octogenarians
T2 - A 1-year analysis of the worldwide e-select registry
AU - Hong, Young Joon
AU - Jeong, Myung Ho
AU - Abizaid, Alexander
AU - Banning, Adrian
AU - Bartorelli, Antonio
AU - Dzavik, Vladimir
AU - Ellis, Stephen G.
AU - Gao, Runlin
AU - Holmes, David R.
AU - Legrand, Victor
AU - Neumann, Franz Josef
AU - Spaulding, Christian
AU - Worthley, Stephen
AU - Urban, Philip
N1 - Funding Information:
Dr. Jeong has relationships with Cordis. Dr. Banning has received research funding from Boston Scientific and Cordis. Dr. Dzavik has been a consultant for Abbott Vascular; has received research funds from Abbott Vascular; and educational grants from Cordis and J & J . Dr. Legrand has been a consultant for Cordis; and a member of the scientific advisory board of Abbott. Dr. Spaulding has received research funding from Cordis, Abbott, Stentys, and Lilly; speaker fees from Cordis, Lilly, and Pfizer; was on the scientific advisory board of Cordis; and has been a full-time employee of Cordis, Johnson & Johnson, since July 1, 2010. Dr. Urban has been a consultant for Cordis and Biosensors. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Robert Harrington, MD, served as the Guest Editor of this paper.
PY - 2011/9
Y1 - 2011/9
N2 - Objectives: The aim of this study was to identify the worldwide practice of Cypher Select (Cordis Corporation, Bridgewater, New Jersey) or Cypher Select Plus sirolimus-eluting stent (SES) in patients 80 years of age (octogenarian) and to identify clinical outcomes in this patient population. Background: The use of drug-eluting stents in elderly patients may have different features compared with younger patients. Methods: Between 2006 and 2008, 15,147 patients from 320 hospitals in 56 countries were enrolled in a registry. Initial implantation and follow-up outcome information obtained at 1-year follow-up in 675 octogenarian patients were compared with those in 14,472 nonoctogenarian patients. Results: Octogenarians had significantly more comorbidities and had higher Charlson comorbidity index scores (1.5 ± 1.6 vs. 1.0 ± 1.3, p < 0.001). Rates of cardiac death (3.3% vs. 0.9%, p < 0.001), myocardial infarction (2.3% vs. 1.9%, p = 0.021), and definite or probable stent thrombosis (2.3% vs. 0.9%, p = 0.0002), and major bleeding (2.0% vs. 0.9%, p = 0.015) were significantly higher in octogenarians at 1 year; however, there was no significant difference in the rate of target lesion revascularization between the 2 groups (3.2% vs. 2.2%, p = 0.12). In octogenarians, a high Charlson comorbidity index was an independent predictor of death and stent thrombosis up to 360 days from the index procedure (hazard ratio: 1.3, 95% confidence interval: 1.1 to 1.5, p < 0.001, and hazard ratio: 1.5, 95% confidence interval: 1.3 to 1.8, p < 0.001, respectively). Conclusions: Stenting with SES may be an effective therapeutic option in elderly patients, with acceptable rates of complications and a very low rate of repeat revascularization as demonstrated by this e-SELECT (A Multi-Center Post-Market Surveillance Registry) subgroup analysis.
AB - Objectives: The aim of this study was to identify the worldwide practice of Cypher Select (Cordis Corporation, Bridgewater, New Jersey) or Cypher Select Plus sirolimus-eluting stent (SES) in patients 80 years of age (octogenarian) and to identify clinical outcomes in this patient population. Background: The use of drug-eluting stents in elderly patients may have different features compared with younger patients. Methods: Between 2006 and 2008, 15,147 patients from 320 hospitals in 56 countries were enrolled in a registry. Initial implantation and follow-up outcome information obtained at 1-year follow-up in 675 octogenarian patients were compared with those in 14,472 nonoctogenarian patients. Results: Octogenarians had significantly more comorbidities and had higher Charlson comorbidity index scores (1.5 ± 1.6 vs. 1.0 ± 1.3, p < 0.001). Rates of cardiac death (3.3% vs. 0.9%, p < 0.001), myocardial infarction (2.3% vs. 1.9%, p = 0.021), and definite or probable stent thrombosis (2.3% vs. 0.9%, p = 0.0002), and major bleeding (2.0% vs. 0.9%, p = 0.015) were significantly higher in octogenarians at 1 year; however, there was no significant difference in the rate of target lesion revascularization between the 2 groups (3.2% vs. 2.2%, p = 0.12). In octogenarians, a high Charlson comorbidity index was an independent predictor of death and stent thrombosis up to 360 days from the index procedure (hazard ratio: 1.3, 95% confidence interval: 1.1 to 1.5, p < 0.001, and hazard ratio: 1.5, 95% confidence interval: 1.3 to 1.8, p < 0.001, respectively). Conclusions: Stenting with SES may be an effective therapeutic option in elderly patients, with acceptable rates of complications and a very low rate of repeat revascularization as demonstrated by this e-SELECT (A Multi-Center Post-Market Surveillance Registry) subgroup analysis.
KW - coronary artery disease
KW - hemorrhagic complication
KW - octogenarian
KW - percutaneous coronary intervention
KW - sirolimus-eluting stent
KW - stent thrombosis
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U2 - 10.1016/j.jcin.2011.06.013
DO - 10.1016/j.jcin.2011.06.013
M3 - Article
C2 - 21939938
AN - SCOPUS:80053042010
SN - 1936-8798
VL - 4
SP - 982
EP - 991
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 9
ER -