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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Coronary artery stenting in the aged

Manish S. Chauhan, MD^* , Richard E. Kuntz, MD, MSc , Kalon K. L. Ho, MD, MSc, FACC^* , David J. Cohen, MD, MSc^*, Jeffrey J. Popma, MD, FACC, Joseph P. Carrozza, Jr, MD, FACC^*, Donald S. Baim, MD, FACC and Donald E. Cutlip, MD, FACC

^* Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Brigham and Women’s Hospital, Boston, Massachusetts, USA
Harvard Clinical Research Institute and Cardiovascular Data Analysis Center, Boston, Massachusetts, USA

Manuscript received April 12, 2000; revised manuscript received October 16, 2000, accepted November 17, 2000.

Reprint requests and correspondence: Dr. Manish S. Chauhan, Interventional Cardiology Section, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215
mchauhan{at}caregroup.harvard.edu

OBJECTIVES

The study compared the safety and efficacy of coronary artery stenting in aged and nonaged patients and identified predictors of adverse clinical outcomes.

BACKGROUND

Limited data are available on the outcomes of stenting in the aged (80 years) compared to nonaged patients.

METHODS

The study was a pooled analysis of 6,186 patients who underwent coronary artery stenting in six recent multicenter trials. A clinical events committee adjudicated clinical end points, and quantitative angiography was performed by an independent core laboratory.

RESULTS

There were 301 (4.9%) aged patients (80 years). Compared to nonaged patients, aged patients had a higher prevalence of multivessel disease (16.5% vs. 9.6%, p = 0.001), unstable angina (50.8% vs. 42.1%, p = 0.003), moderate to severe target lesion calcification (30.4% vs. 15.3%, p = 0.001) and smaller reference vessel diameter (2.90 mm vs. 2.98 mm, p = 0.004). Procedural success rate (97.4% vs. 98.5%, p = 0.14) was similar in the two groups. In-hospital mortality (1.33% vs. 0.10%, p = 0.001), bleeding complications (4.98% vs. 1.00%, p < 0.001) and one-year mortality (5.65% vs. 1.41%, p < 0.001) were significantly higher for the aged patients. Clinical restenosis was similar for the two groups (11.19% vs. 11.93%, p = 0.78). Advanced age, diabetes, prior myocardial infarction and presence of three-vessel disease were independent predictors of long-term mortality.

CONCLUSIONS

Coronary artery stenting can be performed safely in patients 80 years of age, with excellent acute results and a low rate of clinical restenosis, albeit with higher incidences of in-hospital and long-term mortality, and vascular and bleeding complications compared to nonaged patients.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   EPISTENT = Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial   Gp = glycoprotein   MI = myocardial infarction   PCI = percutaneous coronary intervention   QCA = quantitative coronary angiography   QMI = Q-wave myocardial infarction   STARS = Stent Antithrombotic Regimen Study   TLR = target lesion revascularization   TVR = target vessel revascularization

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