Safety and effectiveness of drug-eluting stents versus bare-metal stents in elderly patients with small coronary vessel disease

Abstract

Background: Drug-eluting stents (DES) are more effective than bare-metal stents (BMS) in small coronary vessel disease. Whether this is true in elderly patients, it is unclear, as frailty and a high rate of comorbidities could increase the rate of DES-related complications.

Aims: To assess procedural and long-term clinical outcomes of elderly patients with small vessel disease treated with DES or BMS.

Methods: Consecutive elderly patients (≥ 75 years old) treated with stenting of native small coronary arteries (reference vessel diameter and implanted stent<3mm) were recruited during 2004-2008. Procedural and long-term clinical outcomes were compared between patients treated with BMS and DES. Propensity score-adjusted logistic regression analysis was performed to account for potential selection bias.

Results: Among 293 patients (175 BMS, 118 DES), peri-procedural myocardial infarction (12 [7%] vs. 5 [4%]; P=0.35) and blood transfusions (3 [2%] vs. 0; P=0.08) were not significantly different between the BMS and DES groups. Clinical follow-up (96% of patients, median [interquartile range] follow-up 3.5 [2.4] years) showed significantly lower adjusted major adverse cardiac events (hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.24-0.72; P=0.002) and target vessel revascularization (TVR) (HR 0.33, 95% CI 0.14-0.76; P=0.009) in the DES group. No significant differences were observed between the groups in terms of death, myocardial infarction, stent thrombosis or bleeding.

Conclusions: In this retrospective, non-randomized analysis of the treatment of small vessel disease in elderly patients, DES were as safe and more effective than BMS with a significant reduction in TVR.

Keywords: Angioplastie coronaire percutanée; BMS; Bare-metal stents; DAPT; DES; Drug-eluting stents; Elderly patients; IQR; MACE; MLD; PCI; Patients âgés; Percutaneous coronary intervention; Petits vaisseaux; SD; Small vessel disease; Stent actif; Stent non actif; TVR; bare-metal stents; drug-eluting stents; dual antiplatelet therapy; interquartile range; major adverse cardiac events; minimal lumen diameter; percutaneous coronary intervention; standard deviation; target vessel revascularization.