Stent Implantation In Patients Research Articles

Predictors of coronary artery aneurysm after stent implantation in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

The clinical and angiographic predictors of coronary artery aneurysm (CAA) formation in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are not clear. This study aims to assess the predictors of CAA formation after primary PCI. 3,428 patients who underwent PCI for STEMI were enrolled. The average period of follow-up was mean 48 months (range 35-56 months) after PCI. During this time, 1,304 patients were underwent follow-up coronary angiography. CAA was detected in 21 patients (1.6 %). CAA occurred at the segment of stent implantation in all patients. The clinical and angiographic data were compared between patients with CAA group (n = 21) and without CAA group (n = 1,283). Patients who developed CAA had longer reperfusion time, higher high-sensitiviy C-reactive protein (hs-CRP) levels and neutrophil to lymphocyte ratio than those who had without CAA. Angiographically, CAA developed proximally located lesions and lesion length was significantly greater in patients with CAA than without CAA. Statin and beta-blocker discontinuation were found higher in stent-associated CAA. Every 1 mg/l increase in hs-CRP and implantation of drug eluting stent (DES) were independent predictor of CAA formation after STEMI. Baseline elevated inflammation status and DES implantation in the setting of STEMI may predict the CAA formation.

MGuardTM stent... We beg to differ. Commentary to the article "Long-term follow-up of mesh-covered stent implantation in patients with ST-segment elevation myocardial infarction".

MGuardTM stent... We beg to differ. Commentary to the article "Long-term follow-up of mesh-covered stent implantation in patients with ST-segment elevation myocardial infarction".

The impact of main branch restenosis on long term mortality following drug‐eluting stent implantation in patients with de novo unprotected distal left main bifurcation coronary lesions: The Milan and New‐Tokyo (MITO) registry

In-stent restenosis (ISR) remains one of the main limitations for percutaneous coronary intervention of unprotected distal left main (UDLM). This study aims to demonstrate the impact of main-branch ISR (MB-ISR) on mortality and to clarify the optimal strategy. Between 2002 and 2008, 482 consecutive UDLM patients treated with drug eluting stent (sirolimus and paclitaxel) were evaluated. During follow-up period (median 52.6 months), MB-ISR occurred in 29, SB-ISR in 65, and MB/SB-ISR in 24. Multivariable analysis demonstrated that the independent predictors of MB-ISR were calcification (HR 2.284, p = 0.016), true-bifurcation (HR 2.331, p = 0.024), insulin-dependent diabetes mellitus (insulin-DM) (HR 2.259, p = 0.048). Furthermore, final proximal postdilatation (FPPD) (HR 0.548, p = 0.077), full LM cover approach (FCA) (HR 0.605, p = 0.093) and greater MLD (HR 0.611, p = 0.062) had a tendency to reduce MB-ISR. Furthermore, the occurrence of MB-ISR within 1-year was associated with cardiac-death (HR 2.734, p = 0.017). The patients with MB-ISR had more comorbidities and complex lesions, resulting in higher risk of cardiac mortality as compared to the patients without MB-ISR. Presence of calcification, true-bifurcation and insulin-DM were associated with MB-ISR following UDLM intervention, while FCA, FPPD, and greater MLD seemed to be associated with the low occurrence of MB-ISR.

Effect of olmesartan on the levels of circulating endothelial progenitor cell after drug-eluting stent implantation in patients receiving statin therapy

BackgroundThe endothelial progenitor cell (EPC) plays an important role in repairing vascular injury. Statins and angiotensin II receptor blockers increase the level of circulating EPCs. However, it is unknown whether the angiotensin II receptor blocker olmesartan synergistically acts with statins to increase the levels of circulating EPCs. Moreover, the association between the levels of circulating EPCs and endothelial dysfunction after implantation of drug-eluting stents (DESs) has not been evaluated. MethodsNine patients with stable coronary artery disease underwent percutaneous coronary intervention (PCI) and received DES implantation. All patients received olmesartan in addition to statin therapy after PCI. The dose of olmesartan was based on the physician's discretion as per the patients’ blood pressure. The levels of circulating EPCs were analyzed at baseline, post-PCI, and 1, 2, 3, and 8 months after PCI. Coronary angiography and the acetylcholine provocation test were performed on all patients at 8 months. ResultsAlthough the angiotensin II level significantly changed, the levels of circulating EPCs did not change during 8 months of olmesartan treatment (3.1±0.6cells/ml, 2.5±0.8cells/ml, 2.0±0.6cells/ml, 2.9±0.9cells/ml, 3.0±0.4cells/ml, 3.4±0.8cells/ml, p=0.64). The patients were subsequently divided into two groups based on whether the level of circulating EPCs was less or greater than 4cells/ml at 8 months. There were no significant differences in the mean vessel diameter of each segment (proximal, proximal edge, distal edge, and distal) after the acetylcholine provocation test between the two groups. ConclusionsLow-to-moderate doses of olmesartan might not increase the level of circulating EPCs in patients receiving statin therapy. There might be no association between the levels of circulating EPCs and the degree of coronary vasospasm in the acetylcholine provocation test 8 months after DES implantation.

TCTAP A-084 Impact of Pre-dilatation Strategy on Vessel Response Following Stent Implantation in Patients with De Novo Coronary Artery Lesion

Although follow-up event rates have significantly improved since the introduction of drug-eluting stents, pre-dilatation strategy before stenting is still important to achieve better stent expansion. The Lacrosse non-slip element (NSE) balloon is an angioplasty catheter with 3 longitudinal elements

TCTAP A-170 Efficacy of Everolimus-eluting Stent Implantation in Patients with Small Coronary(≦2.5mm) Arteries: Outcomes of 2-year Clinical Follow-up

TCTAP A-170 Efficacy of Everolimus-eluting Stent Implantation in Patients with Small Coronary(≦2.5mm) Arteries: Outcomes of 2-year Clinical Follow-up

Two-year outcomes after first- or second-generation drug-eluting stent implantation in patients with in-stent restenosis. A PRODIGY trial substudy

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Long-term follow-up of mesh-covered stent implantation in patients with ST-segment elevation myocardial infarction

The MGuard stent (a bare-metal stent wrapped externally in a polymer mesh sleeve) was introduced to reduce the risk of distal embolisation and no-reflow phenomenon during percutaneous coronary intervention (PCI) in thrombus containing lesions, including ST-segment elevation myocardial infarction (STEMI). However, data on the long-term performance of the MGuard stent is limited. To assess the long-term safety and efficacy of MGuard stent implantation during primary PCI for STEMI. In this multicentre study, a total of 60 patients with STEMI ≤12 h treated with the MGuard stent were enrolled. Angiographic success of PCI was achieved in 96.7%, with the final TIMI grade 3 flow in 90.0% of patients. At six months, the overall rate of major adverse cardiac and cerebrovascular events (MACCE; composite of cardiac death, nonfatal target vessel reinfarction, target lesion revascularisation, and stroke) was 1.7%. A long-term follow-up of the study was successfully performed in 57 patients (mean follow-up of 38.7 ± 3.1 months). The long-term cardiac mortality was 7.0%, with a MACCE rate of 8.8%. There was no decrease in the left ventricular ejection fraction and no enlargement of the left ventriclebetween index and long-term follow-up echocardiogram. The early safety and efficacy of the MGuard stent was maintained during the long-term follow-up. However, comparative data from ongoing randomised clinical trials are still required to confirm the long-term efficacy of MGuard stent implantation in patients with STEMI.

Assessment of Characteristics of Neointimal Hyperplasia after Drug-Eluting Stent Implantation in Patients with Diabetes Mellitus: An Optical Coherence Tomography Analysis

Objective: This study aims to assess the characteristics of neointimal hyperplasia after drug-eluting stent (DES) implantation in patients with diabetes mellitus (DM) by optical coherence tomography (OCT). Methods: OCT was performed in 109 patients (45 with DM and 64 without DM) 1 year after DES implantation. Neointimal coverage and thickness on the luminal side were measured. The characteristics of neointimal hyperplasia were classified into three patterns, namely, high signal pattern, low signal pattern and layered signal pattern, according to the neointimal signal intensity. The development of in-stent neoatherosclerosis was also examined. In the DM group, glycated hemoglobin (HbA_1c) levels were analyzed in order to assess their contribution to neointimal characteristics. Results: OCT results indicated that neointimal thickness was thicker in the DM group than in the non-DM group (177.19 ± 165.36 vs. 166.76 ± 132.38 μm, p < 0.001). Lower incidence of high signal pattern (58.33 vs. 75.34%, p = 0.037) and higher incidence of in-stent neoatherosclerosis (18.33 vs. 5.48%, p = 0.027) were observed in the DM group. In the DM subgroup with HbA_1c >7%, significantly higher incidence of low signal pattern (37.50 vs. 21.43%, p = 0.001) and layered signal pattern (18.75 vs. 3.57%, p = 0.001) and lower incidence of high signal pattern were observed (43.75 vs. 75.0%, p < 0.001). In-stent neoatherosclerosis was also frequently detected in the high HbA_1c group compared with the low HbA_1c group (28.13 vs. 7.14%, p = 0.048). Conclusion: Neointimal characteristics differed between DM and non-DM patients. HbA_1c levels in DM patients contributed to the development of neointimal hyperplasia and in-stent neoatherosclerosis.

Optimizing Antithrombotic Therapy After Coronary Stent Implantation in Patients on Chronic Oral Anticoagulation

Most patients on chronic oral anticoagulation have a lifelong indication. When these patients undergo percutaneous coronary interventions with stent implantation, they also have an indication for dual antiplatelet therapy (aspirin and a P2Y12 inhibitor). However, this so-called triple therapy results in increased bleeding risks which in turn is associated with increased mortality. Furthermore, emerging stronger antiplatelet drugs (prasugrel and ticagrelor) are associated with increased bleeding, making triple therapy even more hazardous. This created a clinical treatment dilemma for this subset of patients, and new trials have been designed to explore new treatment strategies. This review summarizes the available evidence regarding the optimal treatment of patients on chronic oral anticoagulation undergoing percutaneous coronary interventions with stent implantation.

Immunochemical Fecal Occult Blood Tests Predict Dual Antiplatelet Therapy Discontinuation after Coronary Stenting

The discontinuation of dual antiplatelet therapy (DAPT) increases the risk of stent thrombosis after coronary stenting. Some patients must discontinue DAPT due to gastrointestinal (GI) tract disease; however, the type of examination that is most useful for detecting GI tract diseases has not been fully evaluated. The purpose of this study was to clarify whether the immunochemical fecal occult blood test (iFOBT) can be used to predict GI tract disease-related DAPT discontinuation following stent implantation in patients with coronary artery disease. A total of 181 consecutive DAPT-naïve patients who underwent coronary stenting were divided into two groups according to the results of iFOBTs: a positive iFOBT group (n=32) and a negative iFOBT group (n=149). During the 12-month follow-up period, the DAPT discontinuation rate was lower in the negative iFOBT group than in the positive iFOBT group (3.4 vs. 18.8%, p=0.005). Kaplan-Meier event-free curves showed that the DAPT discontinuation rate in the negative iFOBT group was lower than that observed in the positive iFOBT group (log-rank test: p=0.001). Logistic and Cox regression analyses showed that a positive iFOBT result was the strongest predictor of the risk of DAPT discontinuation after coronary stenting. A positive iFOBT result is associated with DAPT discontinuation following coronary stenting.

Comparing coronary artery bypass grafting with drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis

Although drug-eluting stents (DESs) reduce the rate of target vessel revascularization compared with bare-metal stents, the results of DESs for patients with diabetes and multivessel coronary artery disease (CAD) in the DES era are inconsistent. This meta-analysis was undertaken to assess the efficacy and safety of coronary artery bypass grafting (CABG) compared with drug-eluting stent implantation in patients with diabetes mellitus and multivessel coronary artery disease. We conducted a search of Medline, EMBASE from January 2003 to July 2013 by two reviewers independently, using the terms 'coronary artery bypass graft surgery', 'drug-eluting stent', 'sirolimus-eluting stent', 'paclitaxel-eluting stent', 'diabetes mellitus' and 'multivessel disease', according to established criteria. Studies comparing CABG with DES in patients with diabetes and multivessel CAD with a minimum follow-up of 1 year were included. Thirteen studies including 6653 patients with diabetes (3237 who underwent CABG and 3416 who underwent DES implantation) met the selection criteria. The mean follow-up period was 2.9 years (range 1-5). Compared with DES, CABG was associated with a lower risk for major adverse cardiac events (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.46-0.58), driven mainly by a lower risk for repeat revascularization (OR 0.29, 95% CI 0.23-0.35). There was no significant difference with regard to death (OR 0.89, 95% CI 0.75-1.05). Patients in the CABG group had a higher risk for stroke events (OR 2.09, 95% CI 1.45-3.02). Percutaneous coronary intervention with DES in patients with diabetes and multivessel CAD is safe, but has a high risk of long-term repeat revascularization. CABG should remain the standard procedure for diabetic patients with multivessel CAD.

Stent implantation in patients with metal allergy

The aim of this study was to assess whether outcomes of patients with metal allergy after coronary stent implantation differ from those of patients without metal allergy. A meta-analysis was carried out to compare the outcome in patients who are allergic to the metal material of a stent with those who are nonallergic. A computer-based online retrieval of databases and manual searches were performed to identify articles that addressed the association between in-stent restenosis (ISR) and contact allergy to stent materials, without language restrictions. The meta-analysis was carried out with a fixed-effect model using STATA 11. Odds ratio (OR) was used as an effect size. Nine relevant articles, encompassing 1223 patients, were identified. Being allergic to stent material obviously increased the risk of ISR. With the fixed model, ORs for allergic patients and nonallergic patients were 2.65 (confidence interval 1.82-3.82). A subgroup analysis of race was carried out. OR in the Asian group was higher than that in the European group (3.71 vs. 2.25), which might suggest that Asians who are allergic to stent material have a higher risk of ISR than Europeans. Allergy to stent material worsens the prognosis of patients with coronary stent implantation. New well-designed prospective clinical trials are required to confirm this relationship and to establish the indispensability of a skin patch test before coronary stent implantation.

Routine Assessment of On-Clopidogrel Platelet Reactivity and Gene Polymorphisms in Predicting Clinical Outcome Following Drug-Eluting Stent Implantation in Patients With Stable Coronary Artery Disease

This study sought to assess the usefulness of clopidogrel-pathway genotyping and on-treatment platelet reactivity (OTR) testing in predicting major adverse cardiac events (MACE) in stable coronary artery disease (CAD) patients receiving drug-eluting stents (DES) under dual antiplatelet (clopidogrel plus aspirin) therapy. The role of pharmacogenetics and OTR in predicting MACE-death, myocardial infarction, or stent thrombosis-in stable CAD patients scheduled for DES implantation is still debated. Patients with stable CAD treated by DES implantation (n= 1,432) were genotyped with a TaqMan OpenArray (Applied Biosystems, Carlsbad, California) and assessed for OTR with the VerifyNow P2Y12 test (Accumetrics Inc., San Diego, California). Genes tested were ABCB1, CYP1A2, CYP2B6*9, CYP2C8*3, CYP2C9*2, CYP2C19, CYP3A4, CYP3A5*3, P2RY12, and PON1CYP2C19. High OTR was defined as P2Y12 reaction units ≥230. The endpoint at 12-month follow-up was MACE occurring during antiplatelet therapy. All groups that were stratified for loss-of-function variants of the cytochrome P450 gene CYP2C19 had significant hazard ratios (HR) for MACE (genotypic HR: 1.41, 95% confidence interval [CI]: 1.06 to 1.89, p= 0.01; allelic HR: 1.56, 95% CI: 2.26 to 1.2, p= 0.01). Variants of other clopidogrel-pathway genes were not significantly associated with MACE. When OTR was assessed, clinical significance was found only in high-risk diabetic (HR: 2.11, 95% CI: 1.29 to 3.45, p < 0.001) and chronic kidney disease (HR: 2.03, 95% CI: 1.03 to 4.02, p= 0.04) patients. CYP2C19 metabolizer status is an independent predictor of MACE after DES implantation and can be used for prognostication in all stable CAD patients. High OTR, as assessed by the VerifyNow P2Y12 test, is an independent predictor of MACE only for high-risk subsets, that is, patients with diabetes or chronic kidney disease.

Long-term effectiveness and safety of triple versus dual antiplatelet therapy after percutaneous coronary intervention for unprotected left main coronary artery disease

We sought to compare the long-term effectiveness and safety of triple antiplatelet therapy (TAPT) versus dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (uLMCAD). An additional strategy to reduce recurrent ischemia after PCI for uLMCAD is needed to improve the long-term clinical outcomes and match the efficacy of bypass surgery. We evaluated 245 patients who underwent PCI with drug-eluting stents for uLMCA stenosis of at least 50% from the Sejong General Institute PCI database between April 2003 and December 2010. TAPT was defined as the addition of cilostazol for at least 3 months to conventional DAPT after PCI. A total of 124 patients received TAPT and 121 patients received DAPT. The TAPT group had a higher number of male patients, need for the two-stent technique, and Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) scores and longer stent length compared with the DAPT group. During a median 30.6 months, major adverse cardiac and cerebrovascular events (MACCE) occurred in 43 patients (17.6%): 23 (18.5%) in the TAPT group and 20 (16.5%) in the DAPT group (P=0.68). In the multivariate analysis, TAPT was not associated with a lower incidence of MACCE (hazard ratio: 0.69, 95% confidence interval: 0.34-1.43). Thrombolysis in myocardial infarction (TIMI) major and minor bleeding occurred at similar rates (5.6 vs. 3.3%, P=0.565, for TIMI major bleeding; and 14.5 vs. 14.9%, P=0.718, for TIMI minor bleeding). TAPT after drug-eluting stent implantation in patients with uLMCAD did not improve the long-term clinical outcome when compared with conventional DAPT, although it was a safe strategy.

Pharmacodynamic response to clopidogrel and outcomes in the ARCTIC randomized trial

Background: The ARCTIC trial failed to demonstrate improvements in outcomes with platelet-function monitoring and treatment adjustment for PCI Aim: To analyze clinical outcome according to clopidogrel pharmacodynamic (PD) response using the VerifyNow assay just before PCI. Methods: Among patients randomized in the monitoring arm of the ARCTIC trial (n=1213), 419 (34.5%) had high on-treatment platelet reactivity (HPR patients) before PCI and underwent treatment adjustment. We compared the occurrence of the composite primary end point (PEP) of death, MI, stent thrombosis, stroke, or urgent revascularization 1 year after stent implantation in patients presenting HPR to clopidogrel before PCI (n=419), non-HPR patients (n=794) and patients randomized in the conventional arm without PD evaluation (n=1227). Safety bleeding endpoints were also analyzed. Results: HPR to clopidogrel was associated with higher age, female gender, higher bodyweight, diabetes and PPI use (all p <0.05). HPR patients underwent more aggressive antiplatelet strategy than non-HPR patients due to the study protocol, with significant more frequent use of GPIIbIIIa inhibitors (79.2% vs. 5.2%, p<0.01), clopidogrel LD (80.2% vs 3.5%, p<0.001) or prasugrel LD before PCI (3.3% vs 0.1%, p<0.001) as compared with non-HPR patients. High clopidogrel MD (150mg or more) (82.6% vs. 32.1%, p<0.001) or prasugrel 10mg MD (18.6% vs. 4.4%%, p<0.001) was also significantly more frequent in HPR patients at discharge as compared with non-HPR patients. The PEP occurred in 34.6% of the patients with HPR who underwent treatment adjustment, in 34.6% of the non-HPR patients (HR 0.97 [0.80; 1.19], p= 0.8) and in 31.1% of the patients randomized in the conventional arm (HR 1.11 [0.91; 1.34] p= 0.31 and 1.14 [0.97; 1.33], p=0.11) for both comparisons). Despite using a much stronger antiplatelet strategies in HPR patients, major bleeding did not differ between HPR patients as compared with non-HPR patients (2.6% vs. 2.1%, respectively, HR 1.19 [0.56; 2.54] p= 0.65) or from patients randomized in the conventional arm of the ARCTIC study (2.6% vs. 3.3%, HR 0.78 [0.40; 1.53] p= 0.47). Conclusion: In ARCTIC, the prognosis of patients with HPR before PCI leading to antiplatelet therapy adjustment did not differ from patients without HPR and without adjustment of therapy. Although, this subgroup analysis comforts the main finding of the study, the hypothesis that tailoring might have corrected impaired prognosis associated with HPR in this high-risk group of patients cannot be eliminated by the ARCTIC study.

Efficacy of everolimus-eluting stent implantation in patients with small coronary arteries: outcomes of 2-year clinical follow-up

Efficacy of everolimus-eluting stent implantation in patients with small coronary arteries: outcomes of 2-year clinical follow-up

Clinical and angiographic outcomes of paclitaxel-eluting stent implantation in patients on maintenance hemodialysis

Clinical and angiographic outcomes of paclitaxel-eluting stent implantation in patients on maintenance hemodialysis

Impact of stent diameter and length on in-stent restenosis after drug eluting stent versus bare metal stent implantation in patients needing large coronary stents

Introduction: The advantage of drug eluting stents (DES) compared to bare metal stents (BMS) is small for the the risk of in-stent-restenosis (ISR) in short lesions of large coronary arteries. Therefore, the British National Institutes of Clinical Excellence (NICE) guidelines recommend to use BMS instead of DES in lesions 3mm diameter. However, no dedicated trial has tested this question. We analysed the impact of stent length and stent diameter on ISR in the BASKET-PROVE study population. Methods: In the multicentre randomized BASKET-PROVE study we compared BMS vs. DES regarding target vessel revascularization (TVR) rates in large coronary arteries (needing ≥3mm stents) resulting in significantly lower 2-year TVR rates in the DES group. For this retrospective subgroup analysis two experienced interventionalists blinded to stent type reviewed all angiographic films for the presence of ISR. We used a mixed-effects Cox survival model to analyse the impact of stent length and stent diameter on ISR on a basis, with ISR being defined as luminal narrowing >50% by visual assessment. Results: 2312 patients with a total of 3278 stented segments were included in the analysis (mean age 63.7±10.9 years; 24.4% female). 123 patients had at least one re-angiography during the two years follow-up due to recurrent ischemia. A total of 75 ISR in 63 patients were observed (mean age 61.9±11.1 years). ISR was significantly more frequent in segments with a BMS (5.3%) compared to segments with a DES (0.74%; HR = 6.18, p<0.001). Based on the Cox analysis, the strongest predictor of ISR was the use of a BMS (hazard ratio (HR)) 6.74; p<0.001). There was a decreased risk of ISR per 1mm increase in stent diameter (HR of 0.30, p=0.003). The HR for stent length per segment was 1.02 (p=0.02; CI= 1.0-1.04) indicating a 2% increased risk of ISR per 1mm increase in stent length. Co-factors like renal failure or diabetes mellitus had no significant effect on ISR. The HR for ISR in patients with stent diameter >3mm and stent length <15mm was not significantly different between the DES and the BMS group although the event rate in this subgroup was low (2.0% with BMS, 1.4% with DES, p=NS). Conclusion: The risk of ISR in patients receiving stents in large coronary arteries is low. Nevertheless, even in patients in need of stents ≥3.0mm, the strongest predictor of ISR was the use of a BMS. Other co-factors like renal failure or DM are not associated with ISR in this population. Alltogether, these findings challenge the restriction of NICE to use BMS instead of DES in vessels >3.0mm.

Impact of advanced age on the safety and effectiveness of paclitaxel‐eluting stent implantation in patients with ST‐segment elevation myocardial infarction undergoing primary angioplasty

To assess the impact of age on safety and efficacy of paclitaxel-eluting stent (PES) implantation during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). The benefits of paclitaxel-eluting stent (PES) implantation during primary PCI were confirmed by the long-term results of the HORIZONS-AMI trial. Whether the effects of PES are independent of age has not been reported. Data on 3,006 patients from the HORIZONS-AMI study randomized in a 3:1 ratio to PES or bare-metal stent (BMS) in whom at least one stent was implanted were assessed. There were 2,302 (76.6%) patients <70, and 704 patients ≥70 years of age. At 3 years, among older patients a trend toward lower risk of major adverse cardiac events (MACE; death from any cause, stroke, reinfarction and unplanned revascularization for ischemia) related to PES use was observed (PES vs. BMS: 18.0% vs. 21.3%; P = 0.07). There was also a trend for reduction of MACE related to PES in older patients (26.4% vs. 33.1%; P = 0.09). Both, patients <70 and ≥70 years of age treated with PES were at lower risk for ischemic target vessel revascularization. However, a higher risk of major bleeding in elderly patients treated with PES was observed (P = 0.02 for interaction between age group and PES effects). No interaction between age and stent type in terms of the risk of other clinical end points, including all-cause death, was confirmed. For STEMI patients undergoing primary PCI, the implantation of PES as compared with BMS reduced ischemic TVR, and this effect was independent of age.