Dudek Dariusz, Mehran Roxana, Dziewierz Artur, Witzenbichler Bernhard, Brodie Bruce R, Kornowski Ran, Fahy Martin, Lansky Alexandra J, Rakowski Tomasz, Legutko Jacek, Bryniarski Leszek, Stone Gregg W
Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Catheter Cardiovasc Interv. 2013 Nov 15;82(6):869-77. doi: 10.1002/ccd.24813. Epub 2013 Aug 1.
To assess the impact of age on safety and efficacy of paclitaxel-eluting stent (PES) implantation during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
The benefits of paclitaxel-eluting stent (PES) implantation during primary PCI were confirmed by the long-term results of the HORIZONS-AMI trial. Whether the effects of PES are independent of age has not been reported.
Data on 3,006 patients from the HORIZONS-AMI study randomized in a 3:1 ratio to PES or bare-metal stent (BMS) in whom at least one stent was implanted were assessed. There were 2,302 (76.6%) patients <70, and 704 patients ≥70 years of age.
At 3 years, among older patients a trend toward lower risk of major adverse cardiac events (MACE; death from any cause, stroke, reinfarction and unplanned revascularization for ischemia) related to PES use was observed (PES vs. BMS: 18.0% vs. 21.3%; P = 0.07). There was also a trend for reduction of MACE related to PES in older patients (26.4% vs. 33.1%; P = 0.09). Both, patients <70 and ≥70 years of age treated with PES were at lower risk for ischemic target vessel revascularization. However, a higher risk of major bleeding in elderly patients treated with PES was observed (P = 0.02 for interaction between age group and PES effects). No interaction between age and stent type in terms of the risk of other clinical end points, including all-cause death, was confirmed.
For STEMI patients undergoing primary PCI, the implantation of PES as compared with BMS reduced ischemic TVR, and this effect was independent of age.
评估年龄对ST段抬高型心肌梗死（STEMI）患者在直接经皮冠状动脉介入治疗（PCI）期间植入紫杉醇洗脱支架（PES）的安全性和有效性的影响。
HORIZONS-AMI试验的长期结果证实了直接PCI期间植入紫杉醇洗脱支架（PES）的益处。PES的效果是否与年龄无关尚未见报道。
评估了HORIZONS-AMI研究中3006例患者的数据，这些患者以3:1的比例随机分为接受PES或裸金属支架（BMS）治疗，且至少植入了一枚支架。年龄<70岁的患者有2302例（76.6%），≥70岁的患者有704例。
3年时，在老年患者中观察到与使用PES相关的主要不良心脏事件（MACE；任何原因导致的死亡、中风、再梗死和因缺血进行的非计划血管重建）风险有降低趋势（PES与BMS：18.0%对21.3%；P = 0.07）。老年患者中与PES相关的MACE也有降低趋势（26.4%对33.1%；P = 0.09）。接受PES治疗的年龄<70岁和≥70岁的患者发生缺血性靶血管重建的风险均较低。然而，观察到接受PES治疗的老年患者发生大出血的风险较高（年龄组与PES效应之间的交互作用P = 0.02）。在包括全因死亡在内的其他临床终点风险方面，未证实年龄与支架类型之间存在交互作用。
对于接受直接PCI的STEMI患者，与BMS相比，植入PES可降低缺血性靶血管重建率，且这种效果与年龄无关。
