Drug-eluting stents associated with benefits in patients age 85 and older

Drug-eluting stents are being used less often in elderly patients, even though their use is associated with better outcomes in these patients, a new study found.

The observational study included more than 400,000 patients who underwent percutaneous coronary intervention (PCI) at 65 years of age or older. Claims data for these patients were collected between 2004 and 2008, and long-term outcomes were compared between patients who received drug-eluting and bare-metal stents. The results were published in the Jan. 10 Journal of the American College of Cardiology.

Researchers found that use of drug-eluting stents in patients 65 and over declined after 2005, with the greatest decline seen in patients age 85 and over. Overall, however, these very elderly patients comprised an increasing percentage of PCIs performed after age 65 (perhaps because periprocedural anticoagulants have reduced the risk of complications, researchers speculated).

In the study population, drug-eluting stents were associated with lower mortality than bare-metal ones, an effect that after adjustment decreased with increasing age (≥85 years, 29% mortality vs. 38%, hazard ratio [HR], 0.80; 75 to 84 years, 17% vs. 25%, HR, 0.77; 65 to 74 years, 10% vs. 16%, HR, 0.73). However, the oldest patients got greater benefit than their younger peers from drug-eluting stents on the outcome of myocardial infarction rehospitalization (≥85 years, 9% vs. 12%, HR, 0.77; 75 to 84 years, 7% vs. 9%, HR, 0.81; 65 to 74 years, 7% vs. 8%, HR, 0.84). In contrast to previous research, the study did not find a lower risk of repeat revascularization associated with drug-eluting stents.

Based on the results, physicians may want to consider use of drug-eluting stents in elderly patients, the authors said. Treatment goals for these patients may be different than for younger patients; for example, maximizing quality of life by avoiding rehospitalization could be more important than reducing repeat revascularization, the researchers noted. The study was limited by its observational design, so future research should further compare PCI treatments in the elderly, focusing on endpoints relevant to these patients, they concluded.