Author/Authors :
de Belder، نويسنده , , Adam and de la Torre Hernandez، نويسنده , , Jose M. and Lopez-Palop، نويسنده , , Ramon and OʹKane، نويسنده , , Peter and Hernandez Hernandez، نويسنده , , Felipe and Strange، نويسنده , , Julian and Gimeno، نويسنده , , Federico and Cotton، نويسنده , , James and Diaz Fernandez، نويسنده , , Jose F. and Carrillo Saez، نويسنده , , Pilar and Thomas، نويسنده , , Martyn and Pinar، نويسنده , , Eduardo and Curzen، نويسنده , , Nick and Baz، نويسنده , , Jose A. and Cooter، نويسنده , , Nina and Lozano، نويسنده , , Inigo and Skipper، نويسنده , , Nicola and Robinson، نويسنده , , Derek and Hildick-Smith، نويسنده , , David، نويسنده ,
Abstract :
Objectives
m of this study was to determine whether drug-eluting stents (DES) are superior to bare-metal stents (BMS) in octogenarian patients with angina.
ound
ts ≥80 years of age frequently have complex coronary disease warranting DES but have a higher risk of bleeding from prolonged dual antiplatelet therapy.
s
ulticenter randomized trial was conducted in 22 centers in the United Kingdom and Spain. Patients ≥80 years of age underwent stent placement for angina. The primary endpoint was a 1-year composite of death, myocardial infarction, cerebrovascular accident, target vessel revascularization, or major hemorrhage.
s
al, 800 patients (83.5 ± 3.2 years of age) were randomized to BMS (n = 401) or DES (n = 399) for treatment of stable angina (32%) or acute coronary syndrome (68%). Procedural success did not differ between groups (97.7% for BMS vs. 95.4% for DES; p = 0.07). Thirty-eight percent of patients had ≥2-vessel percutaneous coronary intervention, and 66% underwent complete revascularization. Patients who received BMS had shorter stent implants (24.0 ± 13.4 mm vs. 26.6 ± 14.3 mm; p = 0.01). Rates of dual antiplatelet therapy at 1 year were 32.2% for patients in the BMS group and 94.0% for patients in the DES group. The primary endpoint occurred in 18.7% of patients in the BMS group versus 14.3% of patients in the DES group (p = 0.09). There was no difference in death (7.2% vs. 8.5%; p = 0.50), major hemorrhage (1.7% vs. 2.3%; p = 0.61), or cerebrovascular accident (1.2% vs. 1.5%; p = 0.77). Myocardial infarction (8.7% vs. 4.3%; p = 0.01) and target vessel revascularization (7.0% vs. 2.0%; p = 0.001) occurred more often in patients in the BMS group.
sions
d DES offer good clinical outcomes in this age group. DES were associated with a lower incidence of myocardial infarction and target vessel revascularization without increased incidence of major hemorrhage. (Xience or Vision Stent–Management of Angina in the Elderly [XIMA]; ISRCTN92243650)
