Abstract 15134: Improved Clinical Outcomes of Patients Aged ≥75 Years Treated with Drug-Eluting Stents Compared to Bare Metal Stents in Large Coronary Arteries: Results from the Basket-Prove Randomized Trail
Objective: To investigate the efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) in patients ≥75 years with large (≥3.0 mm) native vessel disease.
Background: DES improve outcomes in elderly patients with small coronary artery disease (CAD) compared to BMS, but data in elderly patients in need of large coronary stents are sparse and randomised data are not available.
Methods: Planned secondary analysis of the BASKET-PROVE trial, in which 2'314 patients undergoing percutaneous coronary intervention (PCI) for large (≥3.0 mm) native vessel disease were randomized 2:1 to DES (everolimus- versus sirolimus-eluting stents 1:1) versus BMS. All patients received 12 months of dual anti-platelet therapy. The primary endpoint was a composite of cardiac death, non-fatal myocardial infarction (MI), or target vessel revascularization (TVR) at 2 years. Analyses of outcome were performed according to the intention-to-treat principle.
Results: 405 (17.5%) of the of the total study population were ≥75 years. Elderly patients underwent PCI for stable angina in 35.6%, for non-ST-elevation MI in 35.8% and for ST-elevation MI in 28.6% of cases, respectively. Baseline and procedural characteristics were similar for
DES and BMS. At two years, significantly lower rates of the primary endpoint were found for DES compared to BMS (6.6% vs. 15.1%; HR 0.64 [95% CI 0.46-0.88], p=0.005). Rates of MI (1.2% vs. 5.5%; HR 0.44 [0.21-0.83], p=0.009), TVR (2.3% vs. 6.2%; HR 0.59 [0.34-0.99], p=0.046) and all-cause death (7.4% vs. 14.4%; HR 0.7 [0.51-0.95], p=0.02) were also significantly lower in patients receiving DES. Rates of stent thrombosis and bleeding events were similar for DES and BMS.
Conclusions: In patients ≥75 years requiring large (≥3.0 mm) coronary stents, use of DES was highly beneficial compared to BMS and greatly reduced the rate of ischemic events, all-cause death and TVR. These data suggest that DES should be preferred over BMS in elderly patients.
- Percutaneous coronary intervention (PCI)
- Drug eluting stents
- Acute coronary syndromes
- Coronary artery disease
Author Disclosures: D.J. Kurz: None. A.M. Bernheim: None. D. Tüller: None. R. Zbinden: None. R. Jeger: None. C. Kaiser: None. S. Galatius: None. H. Alber: None. M. Pfisterer: None. F.R. Eberli: None.
- © 2014 by American Heart Association, Inc.