Abstract 14804: Acute and 3-year Bleeding Risks: Comparing Drug-Eluting to Bare-Metal Stents in Old and Very Old Adults in a Community Population
Introduction: The rapidly expanding population of older adults is highly susceptible to coronary artery disease, and also to revascularization-related bleeding complications. Although drug eluting stents (DES) have been demonstrated to be more effective than bare metal stents (BMS), the prolonged anti-platelet therapy required for DES may lead to excessive bleeding among older patients.
Methods and Results: We identified all patients aged ≥75 years undergoing percutaneous coronary intervention (PCI) with stenting between April 1, 2003 and September 30, 2005 at all acute care non-federal hospitals in Massachusetts (MA) from a mandatory state database (n=7039). According to index admission stent type, we classified patients as DES-treated if stents were drug-eluting and BMS-treated if stents were bare metal; patients treated with both BMS and DES were excluded. Rates of hospitalization for bleeding were determined from ICD-9 codes; 3-year follow-up was available for the entire cohort. Risk-adjusted cumulative incidence of bleeding was estimated using propensity score matching (2:1 without replacement) based on clinical, procedural, hospital, and insurance information collected at the index admission, including prior history of bleeding, atrial fibrillation or neoplasm. Over the study period, 4996 patients received DES and 2043 received BMS. The unadjusted cumulative incidence of bleeding was 2.5% vs 3.2%, p=0.08, at 30 days (DES vs BMS) and 10.5% vs 10.3%, p=0.81, at 3 years. Among 4858 patients matched by propensity scores (71 1:1 pairs and 1572 2:1 triplets), the risk-adjusted bleeding rates were 3.1 vs 2.7, p=0.43, at 30 days (DES vs BMS) and 11.0% vs 9.8%, p=0.23, at 3 years. Very old patients (≥85 years) (n=1251) showed higher 3-year bleeding rates compared with those 75–84 years (12.8% vs 9.9%, p= 0.002), but risk-adjusted bleeding rates attributable to the choice of stents was not different across the age groups (10.4% vs 9.3%, p=0.376, DES vs BMS, for patients aged 75–84 years and 13.7 vs 12.2%, p= 0.158, for patients ≥85 years).
Conclusions: In a real-world patient population with mandatory reporting, comparison of similar patients treated with DES vs BMS showed no significant difference in rates of acute and late bleeding regardless of advanced age.
- © 2010 by American Heart Association, Inc.