Safety and Efficacy of Coronary Drug-Eluting Stents in Octogenarians

Abstract

The effectiveness of coronary drug-eluting stents has not been fully studied in very elderly patients who have clinical features that predispose them to side effects and long-term adverse events. The safety and efficacy of drug-eluting stents were studied in a historical cohort of consecutive octogenarian patients who underwent percutaneous coronary intervention. Between 2002 and 2006, 176 octogenarian patients were treated using coronary stents: 90 with drug-eluting stents and 86 with bare-metal stents only. Patients treated using drug-eluting stents had a greater number of diseased vessels (2.28+/-0.85 vs. 1.87+/-0.87; P=.002), had more vessels treated (1.74+/-0.79 vs. 1.17+/-0.47; P< .0005), were more likely to have multivessel disease (79% vs. 59%; P=.005) and to undergo left main coronary artery treatment (20% vs. 1.0%; P< .0005), and had longer (26.6+/-6.7 mm vs. 16.6+/-4.9 mm; P< .0005) and smaller diameter (2.91+/-0.4 mm vs. 3.04+/-0.4 mm; P=.049) lesions. The median follow-up period was 26.3+/-12.9 months (in 98.3% of patients). After adjustment for other variables and for the likelihood of receiving a drug-eluting stent (i.e., the propensity score), there was no significant relationship between the type of coronary stent used and either mortality or the occurrence of adverse clinical events at 1 year of follow-up. With careful clinical selection of patients, the use of drug-eluting stents in octogenarians with highly unfavorable angiographic characteristics can be as safe and effective as conventional stents for treating low-risk coronary lesions.