Everolimus-eluting stent versus bare-metal stent in elderly (≥ 75 years) versus non-elderly (< 75 years) patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Insights from the examination trial

Abstract

BackgroundThe elderly (≥75years) constitute a high-risk subset of patients who continue to have a poorer prognosis than non-elderly (<75years). Whether the effects of everolimus-eluting stent (EES) in ST-segment elevation myocardial infarction (STEMI) are independent of age has not been reported. We investigated the outcomes following primary PCI (PPCI) with bare-metal stent (BMS) or EES in elderly vs. non-elderly STEMI patients. MethodsThe EXAMINATION trial randomized 1498 STEMI patients to BMS or EES. The primary patient-oriented endpoint (POCE) was the combined of all-cause death, any-recurrent myocardial infarction (MI) and any-revascularization at 1-year. The secondary endpoint included the device-oriented combined (DOCE) of cardiac death, target-vessel MI and target-lesion revascularization. These endpoints and their components were compared between elderly and non-elderly. ResultsAmong patients enrolled in the trial, 245 (16.3%) were elderly, allocated to BMS (n=132) or EES (n=113), while the remaining 1253 (83.7%) were non-elderly, allocated to BMS (n=615) or EES (n=638). At 1-year, both the POCE and DOCE were observed more frequently in elderly vs. non-elderly group (24.5% vs. 10.5%, p<0.001 and 15.9% vs. 5.1%, p<0.001). Whereas in non-elderly, both POCE and DOCE were lower in EES vs. BMS (12.4% vs. 8.8%, p=0.03 and 6.7% vs. 3.6%, p=0.01), no differences were found in elderly, with a tendency for interaction between age and stent type for POCE (p=0.05). On multivariate analysis age ≥75years was an independent predictor of POCE (HR 2.19 [95%CI 1.59–3.01], p<0.0001) and DOCE (HR 2.42 [95%CI 1.60–3.7], p<0.001) at 1-year. ConclusionsIn STEMI patients undergoing PPCI, advanced age (≥75years) is associated with worse outcomes. The beneficial effects of EES over BMS tended to be age-dependent.