依维莫司洗脱支架与裸金属支架用于≥75岁及<75岁ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗的比较：EXAMINATION试验的见解
Everolimus-eluting stent versus bare-metal stent in elderly (≥75 years) versus non-elderly (<75 years) patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: insights from the examination trial.
作者信息
Ielasi Alfonso, Brugaletta Salvatore, Silvestro Antonio, Cequier Angel, Iñiguez Andrés, Serra Antonio, Hernandez-Antolin Rosana, Mainar Vicente, Valgimigli Marco, den Heijer Pieter, Bethencourt Armando, Vazquez Nicolás, Serruys Patrick, Sabate Manel, Tespili Maurizio
机构信息
Hospital "Bolognini" Seriate, Bergamo, Italy.
University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
出版信息
Int J Cardiol. 2015 Jan 20;179:73-8. doi: 10.1016/j.ijcard.2014.10.038. Epub 2014 Oct 22.
BACKGROUND
The elderly (≥75years) constitute a high-risk subset of patients who continue to have a poorer prognosis than non-elderly (<75years). Whether the effects of everolimus-eluting stent (EES) in ST-segment elevation myocardial infarction (STEMI) are independent of age has not been reported. We investigated the outcomes following primary PCI (PPCI) with bare-metal stent (BMS) or EES in elderly vs. non-elderly STEMI patients.
METHODS
The EXAMINATION trial randomized 1498 STEMI patients to BMS or EES. The primary patient-oriented endpoint (POCE) was the combined of all-cause death, any-recurrent myocardial infarction (MI) and any-revascularization at 1-year. The secondary endpoint included the device-oriented combined (DOCE) of cardiac death, target-vessel MI and target-lesion revascularization. These endpoints and their components were compared between elderly and non-elderly.
RESULTS
Among patients enrolled in the trial, 245 (16.3%) were elderly, allocated to BMS (n=132) or EES (n=113), while the remaining 1253 (83.7%) were non-elderly, allocated to BMS (n=615) or EES (n=638). At 1-year, both the POCE and DOCE were observed more frequently in elderly vs. non-elderly group (24.5% vs. 10.5%, p<0.001 and 15.9% vs. 5.1%, p<0.001). Whereas in non-elderly, both POCE and DOCE were lower in EES vs. BMS (12.4% vs. 8.8%, p=0.03 and 6.7% vs. 3.6%, p=0.01), no differences were found in elderly, with a tendency for interaction between age and stent type for POCE (p=0.05). On multivariate analysis age ≥75 years was an independent predictor of POCE (HR 2.19 [95%CI 1.59-3.01], p<0.0001) and DOCE (HR 2.42 [95%CI 1.60-3.7], p<0.001) at 1-year.
CONCLUSIONS
In STEMI patients undergoing PPCI, advanced age (≥75 years) is associated with worse outcomes. The beneficial effects of EES over BMS tended to be age-dependent.
背景
老年人（≥75岁）是一类高危患者亚组，其预后持续比非老年人（<75岁）差。依维莫司洗脱支架（EES）在ST段抬高型心肌梗死（STEMI）中的作用是否独立于年龄尚未见报道。我们调查了老年与非老年STEMI患者接受裸金属支架（BMS）或EES的直接经皮冠状动脉介入治疗（PPCI）后的结局。
方法
EXAMINATION试验将1498例STEMI患者随机分为BMS组或EES组。以患者为导向的主要终点（POCE）是1年时全因死亡、任何复发性心肌梗死（MI）和任何再血管化的联合终点。次要终点包括心脏死亡、靶血管MI和靶病变再血管化的器械导向联合终点（DOCE）。比较老年和非老年患者的这些终点及其组成部分。
结果
在试验纳入的患者中，245例（16.3%）为老年人，分配至BMS组（n = 132）或EES组（n = 113），其余1253例（83.7%）为非老年人，分配至BMS组（n = 615）或EES组（n = 638）。1年时，老年组的POCE和DOCE发生率均高于非老年组（24.5%对10.5%，p<0.001；15.9%对5.1%，p<0.001）。在非老年人中，EES组的POCE和DOCE均低于BMS组（12.4%对8.8%，p = 0.03；6.7%对3.6%，p = 0.01），而在老年人中未发现差异，POCE存在年龄与支架类型之间的交互作用趋势（p = 0.05）。多因素分析显示，年龄≥75岁是1年时POCE（HR 2.19 [95%CI 1.59 - 3.01]，p<0.0001）和DOCE（HR 2.42 [95%CI 1.60 - 3.7]）的独立预测因素，p<0.001）。
结论
在接受PPCI的STEMI患者中，高龄（≥75岁）与更差的结局相关。EES相对于BMS的有益作用往往与年龄有关。
Zotero 插件