Published Online
on June 2, 2009

A more recent version of this article appeared on June 1, 2009

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Original Article

Long-Term Paclitaxel-Eluting Stent Outcomes in Elderly Patients

Daniel E. Forman^1,10; David A. Cox²; Stephen G. Ellis³; John M. Lasala⁴; John A. Ormiston⁵; Gregg W. Stone⁶; Mark A. Turco⁷; Jeanne Y. Wei⁸; Anita A. Joshi⁹; Keith D. Dawkins⁹ and Donald S. Baim⁹

¹ Brigham and Women's Hospital and the VA Boston Health Care System, Boston, MA;
² Lehigh Valley Hospital, Allentown, PA;
³ Cleveland Clinic, Cleveland, OH;
⁴ Washington University School of Medicine, St. Louis, MO;
⁵ Mercy Hospital, Auckland, New Zealand;
⁶ The Cardiovascular Research Foundation, New York, NY;
⁷ Center for Cardiac and Vascular Research, Washington Adventist Hospital, Takoma Park, MD;
⁸ University of Arkansas for Medical Sciences and GRECC, CAVHS, Little Rock, AR;
⁹ Boston Scientific Corporation, Natick, MA

¹⁰ E-mail: deforman{at}partners.org

Background—While drug-eluting stents (DES) have become a mainstay of percutaneous coronary intervention (PCI), information about DES 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 to bare metal stents (BMS).

Methods and Results—Data from 5 randomized trials (2,271 PES patients, 1,397 BMS patients) and from 2 post-market registries (7,492 PES patients) were pooled separately. Each dataset was stratified into age groups; <60, 60-70, and >70 years. At baseline, patients >70 in both datasets had significantly more adverse characteristics than younger patients. Through 5 years, trial data showed that patients >70 had higher death rates, but comparable rates of myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) to younger patients. Compared to BMS patients, PES patients >70 had comparable rates of death, MI, and ST but significantly lower TLR rate (22.2 vs. 10.2, P<0.001). These findings were echoed in the registry data through 2 years that showed that PES patients >70 had significantly higher death rates, but lower MI, ST, and TLR rates, compared to younger patients. While the mortality rates of patients >70 were higher than those of younger patients, they were comparable to those of age- and gender-matched norms in the general population.

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

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