[en] 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.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Hong, Young Joon
Jeong, Myung Ho
Abizaid, Alexander
Banning, Adrian
Bartorelli, Antonio
Dzavik, Vladimir
Ellis, Stephen G.
Gao, Runlin
Holmes, David R. Jr
Legrand, Victor ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie
K.G. Manton, and J.W. Vaupel Survival after the age of 80 in the United States, Sweden, France, England, and Japan N Engl J Med 333 1995 1232 1235
M. Feinleib, R.J. Havlik, and R.F. Gillum Coronary heart disease and related procedures: National Hospital Discharge Survey data Circulation 79 Suppl I 1989 I113 I118
E.D. Peterson, J.G. Jollis, and J.D. Bebchuk Changes in mortality after myocardial revascularization in the elderly Ann Intern Med 121 1994 919 927
D.E. Wennberg, D.J. Makenka, A. Sengupta The Northern New England Cardiovascular Disease Study Group Percutaneous transluminal coronary angioplasty in the elderly: epidemiology, clinical risk factors, and in-hospital outcomes Am Heart J 137 1999 639 645 (Pubitemid 29173575)
W.B. Batchelor, K.J. Anstrom, L.H. Muhlbaier National Cardiovascular Network Collaboration Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: results in 7,472 octogenarians J Am Coll Cardiol 36 2000 723 730
R.K. Myler, J.G. Webb, and K.P. Nguyen Coronary angioplasty in octogenarians: comparisons to coronary bypass surgery Cathet Cardiovasc Diagn 23 1991 3 9
T. Little, M.R. Milner, K. Lee, J. Constantine, A.D. Pichard, and J. Lindsay Late outcome and quality of life following percutaneous transluminal coronary angioplasty in octogenarians Cathet Cardiovasc Diagn 29 1993 261 266 (Pubitemid 23219004)
J.H. O'Keefe Jr., M.B. Sutton, and B.D. McCallister Coronary angioplasty versus bypass surgery in patients > 70 years old matched for ventricular function J Am Coll Cardiol 24 1994 425 430 (Pubitemid 24246544)
D.A. Morrison, R.D. Bies, and J. Sacks Coronary angioplasty for elderly patients with "high risk" unstable angina: short-term outcomes and long-term survival J Am Coll Cardiol 29 1997 339 344 (Pubitemid 27059963)
R.C. Thompson, D.R. Holmes Jr., D.E. Grill, M.B. Mock, and K.R. Bailey Changing outcome of angioplasty in the elderly J Am Coll Cardiol 27 1996 8 14 (Pubitemid 26018914)
D.E. Forman, A.D. Berman, C.H. McCabe, D.S. Baim, and J.Y. Wei PTCA in the elderly: the "young-old" versus the "old-old." J Am Geriatr Soc 40 1992 19 22
J.O. Santana, J.I. Haft, N.S. LaMarche, and J.E. Goldstein Coronary angioplasty in patients eighty years of age or older Am Heart J 124 1992 13 18
R.C. Thompson, D.R. Holmes Jr., B.J. Gersh, M.B. Mock, and K.R. Bailey Percutaneous transluminal coronary angioplasty in the elderly: early and long-term results J Am Coll Cardiol 17 1991 1245 1250
J. Lindsay Jr., V.M. Reddy, E.E. Pinnow, T. Little, and A.D. Pichard Morbidity and mortality rates in elderly patients undergoing percutaneous coronary transluminal angioplasty Am Heart J 128 1994 697 702 (Pubitemid 24314657)
L.W. Klein, P. Block, R.G. Brindis ACC-NCDR Registry Percutaneous coronary interventions in octogenarians in the American College of Cardiology-National Cardiovascular Data Registry: development of a nomogram predictive of in-hospital mortality J Am Coll Cardiol 40 2002 394 402 (Pubitemid 34833151)
H.A. Cohen, D.O. Williams, D.R. Holmes Jr. NHLBI Dynamic Registry Impact of age on procedural and 1-year outcome in percutaneous transluminal coronary angioplasty: a report from the NHLBI Dynamic Registry Am Heart J 146 2003 513 519 (Pubitemid 37083088)
J. De Gregorio, Y. Kobayashi, and R. Albiero Coronary artery stenting in the elderly: short-term outcome and long-term angiographic and clinical follow-up J Am Coll Cardiol 32 1998 577 583 (Pubitemid 28435239)
V.S. DeGeare, G.W. Stone, and L. Grines Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials) Am J Cardiol 86 2000 30 34 (Pubitemid 30365139)
K.P. Alexander, K.J. Anstrom, and L.H. Muhlbaier Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network J Am Coll Cardiol 35 2000 731 738 (Pubitemid 30167031)
P. Urban, A. Abizaid, and A. Banning Stent thrombosis and bleeding complications after implantation of sirolimus-eluting coronary stents in an unselected worldwide population: a report from the e-SELECT (Multi-Center Post-Market Surveillance) registry J Am Coll Cardiol 57 2011 1445 1454
M.E. Charlson, P. Pompei, K.L. Ales, and C.R. MacKenzie A new method of classifying prognostic comorbidity in longitudinal studies: development and validation J Chronic Dis 40 1987 373 383 (Pubitemid 17055592)
W. D'Hoore, A. Bouckaert, and C. Tilquin Practical considerations on the use of the Charlson comorbidity index with administrative databases J Clin Epidemiol 49 1996 1429 1433 (Pubitemid 27028932)
W.A. Ghali, R.E. Hall, A.K. Rosen, A.S. Ash, and M.A. Moskowitz Searching for an improved clinical comorbidity index for use with ICD-9-CM administrative data J Clin Epidemiol 49 1996 273 278 (Pubitemid 26149646)
P.A. Rochon, J.N. Katz, and L.A. Morrow Comorbid illness is associated with survival and length of stay in patients with chronic disability A prospective comparison of three comorbidity indices Med Care 34 1996 1093 1101 (Pubitemid 126433208)
P.S. Romano, L.L. Roos, and J.G. Jollis Adapting a clinical comorbidity Index for use with ICD-9-CM administrative data: differing perspectives J Clin Epidemiol 46 1993 1075 1079
D.W. West, W.A. Satariano, D.R. Ragland, and R.A. Hiatt Comorbidity and breast cancer survival: a comparison between black and white women Ann Epidemiol 6 1996 413 419 (Pubitemid 26372529)
D.E. Cutlip, S. Windecker, R. Mehran Academic Research Consortium Clinical end points in coronary stent trials: a case for standardized definitions Circulation 115 2007 2344 2351 (Pubitemid 46685903)
G. Montalescot, H.D. White, R. Gallo STEEPLE Investigators Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention N Engl J Med 355 2006 1006 1017 (Pubitemid 44343544)
C.L. Grines, R.O. Bonow, and D.E. Casey Jr. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and American Dental Association, with representation from the American College of Physicians Circulation 115 2007 813 818 (Pubitemid 46294748)
S.R. Steinhubl, P.B. Berger, J.T. Mann 3rd CREDO Investigators Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial JAMA 288 2002 2411 2420 (Pubitemid 35340537)
S.R. Mehta, S. Yusuf, R.J. Peters Clopidogrel in Unstable angina to prevent Recurrent Events Trial (CURE) Investigators Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study Lancet 358 2001 527 533 (Pubitemid 32772726)
K.Y. Chen, S.W. Rha, Y.J. Li Korea Acute Myocardial Infarction Registry Investigators Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention Circulation 119 2009 3207 3214
A. Latib, N. Morici, and J. Cosgrave Incidence of bleeding and compliance on prolonged dual antiplatelet therapy (aspirin + thienopyridine) following drug-eluting stent implantation Am J Cardiol 102 2008 1477 1481
P.S. Douglas, J.M. Brennan, and K.J. Anstrom Clinical effectiveness of coronary stents in elderly persons: results from 262,700 Medicare patients in the American College of Cardiology-National Cardiovascular Data Registry J Am Coll Cardiol 53 2009 1629 1641
K.C. Floyd, J.E. Jayne, and A.V. Kaplan Age-based differences of percutaneous coronary intervention in the drug-eluting stent era J Interv Cardiol 19 2006 381 387 (Pubitemid 44511067)
Y. Kataoka, S. Yasuda, I. Morii, A. Kawamura, and S. Miyazaki Improved long-term prognosis of elderly women in the era of sirolimus-eluting stents Circ J 73 2009 1219 1227