NEW YORK (Reuters Health) – For octogenarians undergoing percutaneous coronary intervention, the use of drug-eluting stents is safe and more effective than using bare metal stents, a Dutch team reports in the American Journal of Cariology online September 28.

Dr. Ron T. van Domburg and colleagues at Erasmus University Medical Center, Rotterdam, identified 319 octogenarians (mean age 83) among 6129 patients who underwent PCI at the center and were eligible for evaluation. Among the octogenarians, 52 received a sirolimus-eluting stent (SES), 174 were given a paclitaxel-eluting stent (PES), and 93 a bare metal stent (BMS).

The main study end points were all-cause mortality and major adverse cardiac events (MACEs), “defined as all-cause death, any myocardial infarction, or any revascularization.”

Median follow-up was 5.4 years. Cumulative 5-year rates of death/MI-free survival were 54% in patients with SESs, 56% in those with PESs, and 58% with BMSs. After multivariate analysis, these rates were not significantly different.

However, due to a trend toward less target vessel revascularization, 5-year rates of MACE-free survival were significantly different between drug-eluting stents and bare metal stents: 52% with SESs, 47% with PESs, and 44% with BMSs.

In discussing the findings, Dr. van Domburg and colleagues note that the justification for using drug-eluting stents in elderly patients has recently been questioned.

“On the one hand,” they write, “it might be viewed as a ‘waste of money’ if they are very likely to die soon because of their advanced age. On the other hand, if these very elderly patients could be spared a second procedure with its attendant risks, that is all the better.”

On the latter point, the authors conclude that their study confirms “that drug-eluting stents may decrease repeat interventions in octogenarians.”

Reference:

Comparison of Five-Year Outcome of Octogenarians Undergoing Percutaneous Coronary Intervention With Drug-Eluting Versus Bare-Metal Stents (from the RESEARCH and T-SEARCH Registries)

Am J Cardiol 2010;