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Original Articles

Long-Term Paclitaxel-Eluting Stent Outcomes in Elderly Patients

Daniel E. Forman, MD; David A. Cox, MD; Stephen G. Ellis, MD; John M. Lasala, MD; John A. Ormiston, MD; Gregg W. Stone, MD; Mark A. Turco, MD; Jeanne Y. Wei, MD; Anita A. Joshi, PhD; Keith D. Dawkins, MD and Donald S. Baim, MD

From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital, Takoma Park, Md; University of Arkansas for Medical Sciences and GRECC (J.Y.W.), CAVHS, Little Rock, Ark; and Boston Scientific Corporation (A.A.J., K.D.D., D.S.B.), Natick, Mass.

Correspondence to Daniel E. Forman, MD, Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis St, Boston, MA 02115. E-mail deforman{at}partners.org

Received January 30, 2009; accepted April 21, 2009.

Background— Although drug-eluting stents have become a mainstay of percutaneous coronary intervention, information about drug-eluting stents outcomes in elderly patients is limited. Data from the paclitaxel-eluting stent (PES) trials and registries were pooled to assess PES benefits relative to advancing patient age, including comparison with bare-metal stents.

Methods and Results— Data from 5 randomized trials (2271 patients with PES, 1397 patients with bare-metal stents) and from 2 postmarket registries (7492 patients with PES) were pooled separately. Each dataset was stratified into age groups: <60, 60 to 70, and >70 years. At baseline, patients aged >70 years in both datasets had significantly more adverse characteristics than younger patients. Through 5 years, trial data showed that patients aged >70 years had higher death rates, but comparable rates of myocardial infarction, stent thrombosis, and target lesion revascularization with younger patients. Compared with patients with bare-metal stents, patients with PES aged >70 years had comparable rates of death, myocardial infarction, and stent thrombosis but a significantly lower target lesion revascularization rate (22.2 versus 10.2, P<0.001). These findings were echoed in the registry data through 2 years that showed that PES patients aged >70 years had significantly higher death rates, but lower myocardial infarction, stent thrombosis, and target lesion revascularization rates, compared with younger patients. Although the mortality rates of patients aged >70 years were higher than those of younger patients, they were comparable with those of age- and gender-matched norms in the general population.

Conclusions— This analysis of almost 10 000 patients demonstrated that percutaneous coronary intervention with PES is a safe and an effective treatment option that should not be withheld based on age.

Key Words: aging • coronary disease • revascularization • paclitaxel-eluting stents

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CLINICAL PERSPECTIVE

Ph. Gabriel Steg, MD, was Guest Editor for this article.