Jorge Belardi1, Ganesh Manoharan2, Mariano Albertal3, Petr Widimský4, Franz-Joseph Neumann5, Sigmund Silber6, Martin B Leon7, Shigeru Saito8. 1. Department of Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. 2. Cardiology Department, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom. 3. Department of Cardiac Surgery and Department of Images, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. 4. Cardiology Department, the Third Faculty of Medicine, Charles University & University Hospital Royal Vineyards, Prague, Czech Republic. 5. Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany. 6. Department of Cardiology, Heart Centre at the Isar, Munich, Germany. 7. Department of Medicine, Division of Cardiology, Columbia University Medical Center and NewYork-Presbyterian Hospital, New York, New York. 8. Department of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan.
Abstract
AIMS: To evaluate the rate of clinical events and bleeding risk according to age in patients undergoing percutaneous coronary intervention (PCI) with a new-generation drug-eluting stent (DES) enrolled in the RESOLUTE Global Clinical Program. METHODS: This study represents a pooled analysis of five trials included in the RESOLUTE program including 5,130 patients, of whom 1,675 (32.6%) were ≥70 years old (elderly patients). RESULTS: After adjusting for confounders, age ≥70 years was a significant predictor of high mortality at 30 days (0.6 vs. 0.1%, P = 0.017) and 2 years (7.2 vs. 2%, P < 0.001). No differences were seen with respect to acute myocardial infarction (MI) or target lesion and vessel revascularization rates between young and elderly patients. Bleeding rates were higher in the elderly throughout follow-up. In the elderly, 7 of the 27 (26%) patients with bleeding episodes died, with a median time between bleeding episode to death of 21 days. In the younger population, 1 patient of 17 with a bleeding episode died (400 days later). CONCLUSIONS: Elderly patients undergoing PCI with a new-generation DES have increased mortality and bleeding risk, with similar rates of acute MI and repeat revascularization. Bleeding risk was higher in the elderly and strongly related to death. Target lesion failure rates were not significantly different between the two age groups, suggesting that the Resolute zotarolimus-eluting stent (R-ZES) is effective for patients younger and older than 70 years of age. R-ZES may be recommended for elderly patients when PCI with a DES is identified as a suitable option.
AIMS: To evaluate the rate of clinical events and bleeding risk according to age in patients undergoing percutaneous coronary intervention (PCI) with a new-generation drug-eluting stent (DES) enrolled in the RESOLUTE Global Clinical Program. METHODS: This study represents a pooled analysis of five trials included in the RESOLUTE program including 5,130 patients, of whom 1,675 (32.6%) were ≥70 years old (elderly patients). RESULTS: After adjusting for confounders, age ≥70 years was a significant predictor of high mortality at 30 days (0.6 vs. 0.1%, P = 0.017) and 2 years (7.2 vs. 2%, P < 0.001). No differences were seen with respect to acute myocardial infarction (MI) or target lesion and vessel revascularization rates between young and elderly patients. Bleeding rates were higher in the elderly throughout follow-up. In the elderly, 7 of the 27 (26%) patients with bleeding episodes died, with a median time between bleeding episode to death of 21 days. In the younger population, 1 patient of 17 with a bleeding episode died (400 days later). CONCLUSIONS: Elderly patients undergoing PCI with a new-generation DES have increased mortality and bleeding risk, with similar rates of acute MI and repeat revascularization. Bleeding risk was higher in the elderly and strongly related to death. Target lesion failure rates were not significantly different between the two age groups, suggesting that the Resolute zotarolimus-eluting stent (R-ZES) is effective for patients younger and older than 70 years of age. R-ZES may be recommended for elderly patients when PCI with a DES is identified as a suitable option.