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Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials

BACKGROUND: Current guidelines recommend newer generation drug-eluting stents (DES) over bare-metal stents (BMS) in patients with ischemic heart disease. However, there is no age-specific recommendation in elderly patients. METHODS: Meta-analysis was performed of 6 randomized studies enrolling 5,042...

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Autores principales: Bae, SungA, Kim, Yongcheol, Gogas, Bill D., Kim, Min Chul, Sim, Doo Sun, Hong, Young Joon, Kim, Ju Han, Ahn, Youngkeun, Jeong, Myung Ho
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Via Medica 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078958/
https://www.ncbi.nlm.nih.gov/pubmed/31702046
http://dx.doi.org/10.5603/CJ.a2019.0109
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author Bae, SungA
Kim, Yongcheol
Gogas, Bill D.
Kim, Min Chul
Sim, Doo Sun
Hong, Young Joon
Kim, Ju Han
Ahn, Youngkeun
Jeong, Myung Ho
author_facet Bae, SungA
Kim, Yongcheol
Gogas, Bill D.
Kim, Min Chul
Sim, Doo Sun
Hong, Young Joon
Kim, Ju Han
Ahn, Youngkeun
Jeong, Myung Ho
author_sort Bae, SungA
collection PubMed
description BACKGROUND: Current guidelines recommend newer generation drug-eluting stents (DES) over bare-metal stents (BMS) in patients with ischemic heart disease. However, there is no age-specific recommendation in elderly patients. METHODS: Meta-analysis was performed of 6 randomized studies enrolling 5,042 elderly patients who underwent percutaneous coronary intervention (PCI) with stent implantation (DES, n = 2,579; BMS, n = 2,463). RESULTS: Combined data indicated a significant reduction in major adverse cardiovascular events (MACEs) with use of DES (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44–0.71, p < 0.001). Moreover, use of DES was associated with a significantly lower incidence of myocardial infarction (OR 0.54, 95% CI 0.36–0.81, p = 0.003) and repeat revascularization (OR 0.44, 95% CI 0.31–0.62, p < 0.001), was compared to that with the use of BMS. Stent thrombosis and bleeding complication rates were not significantly different between groups. In a subgroup meta-analysis, short duration (1 or 6 months) dual antiplatelet therapy (DAPT) was associated with a significantly lower MACE rate (OR 0.49, 95% CI 0.34–0.80; p = 0.003) in elderly patients who underwent PCI with everolimus-eluting stent implantation, compared with that using long duration DAPT. CONCLUSIONS: This meta-analysis provides clinically relevant evidence that DES rather than BMS should be selected for elderly patients.
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spelling pubmed-80789582021-05-10 Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials Bae, SungA Kim, Yongcheol Gogas, Bill D. Kim, Min Chul Sim, Doo Sun Hong, Young Joon Kim, Ju Han Ahn, Youngkeun Jeong, Myung Ho Cardiol J Interventional Cardiology BACKGROUND: Current guidelines recommend newer generation drug-eluting stents (DES) over bare-metal stents (BMS) in patients with ischemic heart disease. However, there is no age-specific recommendation in elderly patients. METHODS: Meta-analysis was performed of 6 randomized studies enrolling 5,042 elderly patients who underwent percutaneous coronary intervention (PCI) with stent implantation (DES, n = 2,579; BMS, n = 2,463). RESULTS: Combined data indicated a significant reduction in major adverse cardiovascular events (MACEs) with use of DES (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44–0.71, p < 0.001). Moreover, use of DES was associated with a significantly lower incidence of myocardial infarction (OR 0.54, 95% CI 0.36–0.81, p = 0.003) and repeat revascularization (OR 0.44, 95% CI 0.31–0.62, p < 0.001), was compared to that with the use of BMS. Stent thrombosis and bleeding complication rates were not significantly different between groups. In a subgroup meta-analysis, short duration (1 or 6 months) dual antiplatelet therapy (DAPT) was associated with a significantly lower MACE rate (OR 0.49, 95% CI 0.34–0.80; p = 0.003) in elderly patients who underwent PCI with everolimus-eluting stent implantation, compared with that using long duration DAPT. CONCLUSIONS: This meta-analysis provides clinically relevant evidence that DES rather than BMS should be selected for elderly patients. Via Medica 2021-04-13 /pmc/articles/PMC8078958/ /pubmed/31702046 http://dx.doi.org/10.5603/CJ.a2019.0109 Text en Copyright © 2021 Via Medica https://creativecommons.org/licenses/by-nc-nd/4.0/This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
spellingShingle Interventional Cardiology
Bae, SungA
Kim, Yongcheol
Gogas, Bill D.
Kim, Min Chul
Sim, Doo Sun
Hong, Young Joon
Kim, Ju Han
Ahn, Youngkeun
Jeong, Myung Ho
Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials
title Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials
title_full Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials
title_fullStr Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials
title_full_unstemmed Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials
title_short Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials
title_sort efficacy and safety of drug-eluting stents in elderly patients: a meta-analysis of randomized trials
topic Interventional Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078958/
https://www.ncbi.nlm.nih.gov/pubmed/31702046
http://dx.doi.org/10.5603/CJ.a2019.0109
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