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Limited data exist on contemporary age-related differences in long-term outcomes of coronary patients receiving drug eluting stents. In this study we evaluate differences in outcomes in young (< 65 years) (Y) and elderly (≥ 65 years) (E) patients for target lesion failure (TLF) at 2-year follow-up in an unselected consecutive series of patients treated with the everolimus- (EES) and paclitaxel-eluting (PES) stents at a tertiary medical center.
Data on 347 consecutive patients (Y 149; E 198) stented with the EES and PES were retrospectively analyzed. The primary endpoint of the study was to compare age related outcomes in TLF defined as the combined endpoint of cardiac death, non fatal myocardial infarction and target lesion revascularization (TLR). Secondary endpoints included TLR, target vessel failure (TVF), target vessel revascularization (TVR), acute stent thrombosis (ST) as defined by the academic research consortium (ARC) and cardiac death. Analysis was done with number of patients as the denominator. Cine angiograms of the first consecutive 163 patients (Y 64; E 99) were independently reviewed by a cardiologist blinded to clinical outcome and SYNTAX scoring was performed. Follow-up was achieved using medical records and/or phone calls and was censored at 2 years. Descriptive analysis was performed on all variables. Univariate analysis and propensity matched analysis were performed to determine differences between the 2 cohorts.
E had more hypertension and a higher angiographic complexity than Y patients as judged by SYNTAX scoring (E 22.4 ± 14.2; Y 17.5 ± 12.5, p = 0.026). A higher prevalence of smoking, obesity and family history of premature heart disease was seen in Y patients. At 2 years follow up, Y vs. E patients had the following outcomes respectively: TLF 27.7% and 25.5% (p=0.711), TLR (24.8% vs. 21.4%, p=0.518), cardiac death (3.4% vs. 2.5%, p=0.750) and definite and probable stent thrombosis (2.0% vs. 1.0%). Propensity matched analysis showed a statistically similar TLF and TVF between the Y and E cohorts respectively (31.3% vs. 21.9% (p=0.317) and 46.2% vs. 32.3% (p=0.150) respectively). The EES had lower TLR than PES in the E (15.7% vs. 27.7%, p=0.055) but similar outcomes between the 2 stents were seen in the Y cohort.
In this cohort of patients receiving EES and PES, and when compared to young patients (< 65 years), elderly patients (≥ 65 years) had more complex angiographic disease but statistically similar outcomes at 2- year follow-up. EES appears to have lower TLR in elderly patients than PES.
- 2013 American College of Cardiology Foundation