Superior outcomes of DES compared with BMS in very elderly population

Drug-eluting stents (DES) in the general population are preferred over bare-metal stents (BMS); they even play a role in treatment of the (very) elderly. Recent results indicate superior outcomes of DES in in patients in their eighties and nineties.

Mishra et al. presented results of a retrospective observational analysis of claims data. The authors aimed to compare outcomes between the two types of stent in this very elderly population, using an American nationwide readmission database (2010-2014) to identify patients aged 80 years who had percutaneous coronary intervention (PCI) using DES or BMS based on international classification of disease codes (9th revision [ICD:9-CM]) [1]. Primary endpoints were 30-day readmission, in-hospital mortality, post-procedure complications, and cost of care. A total of 297,378 qualifying subjects were identified (30.7% BMS; 69.3% DES). Significantly less utilisation of DES was observed in nonagenarians vs octogenarians (56.75% vs 70.56%, P0.001).

DES recipients had lower burden of comorbidities than BMS recipients (Charlson comorbidity index 2: 55.48% vs 63.61%), as well as significantly lower rates of in-hospital mortality (2.93% vs 6.41%, P0.001), 30-day readmission (octogenarians: 15.04% vs 18.4%, P0.001; nonagenarians: 18.52% vs 20.56%, P0.001), post-procedural complications (10.3% vs 15.7%, P0.001), and cost of care (24.8 vs 25.1 thousand USD, P=0.013). On multivariate analysis, the use of DES was associated with significantly lower 30-day readmission rates, composite endpoint of post-procedural complications and mortality. Thus, it was concluded the use of DES is associated with superior outcomes to BMS in the very elderly population. Researchers pointed out that future studies are needed to identify the barriers responsible for DES underutilisation in this population.

1. Mishra A, et al. Abstract 1329-360. ACC 2019, 16-18 March, New Orleans, USA.



Posted on 4 June, 201919 November, 2021