Kitabata Hironori, Kubo Takashi, Mori Kazuya, Yamamoto Yasunori, Kashiwagi Manabu, Arita Yu, Tanimoto Takashi, Akasaka Takashi
Department of Cardiovascular Medicine, Shingu Municipal Medical Center, Wakayama, Japan.
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Cardiovasc Revasc Med. 2018 Jan;19(1 Pt A):12-16. doi: 10.1016/j.carrev.2017.05.022. Epub 2017 Jun 1.
In patients ≥80 years of age, the use of second-generation cobalt-chromium everolimus-eluting stents (CoCr-EES) versus bare-metal stents has been shown to reduce myocardial infarction (MI) and target vessel revascularization (TVR) rates, without an increase in bleeding. However, safety and efficacy of CoCr-EES in octogenarians compared to younger populations are less certain. We aimed to compare the clinical outcomes between octogenarian and non-octogenarian patients undergoing percutaneous coronary intervention (PCI) with CoCr-EES.
We retrospectively analyzed 186 patients treated with CoCr-EES; 54 octogenarians (63 lesions) and 132 non-octogenarians (152 lesions). The primary endpoint was a 1-year composite of all-cause death, MI, TVR, cerebrovascular accident (CVA), or major bleeding. Stent thrombosis (ST) was also evaluated.
Radial approach was used in 70.4% of octogenarians versus 80.3% of non-octogenarians (p = 0.18). Rates of dual antiplatelet therapy at 1 year were 90.7% for octogenarians and 90.9% for non-octogenarians (p = 1.00). The primary endpoint occurred in 14.8% of octogenarians and 11.4% of non-octogenarians (p = 0.52). There were no significant differences with respect to the rates of 1-year all-cause death (7.4% vs. 3.8%, p = 0.30), MI (1.9% vs. 1.5%, p = 1.00), TVR (3.7% vs. 5.3%, p = 0.65), CVA (1.9% vs. 2.3%, p = 1.00), and definite/probable ST (1.9% vs. 1.5%, p = 1.00) between the 2 groups. Major bleeding was observed in only 1 of octogenarians. Multivariate analysis demonstrated that chronic kidney disease and intravascular ultrasound use were the only independent predictors of the primary endpoint.
According to our series, 1-year safety and efficacy outcomes of CoCr-EES PCI in octogenarians were comparable to those in non-octogenarians.
We compared the clinical outcomes between octogenarian and non-octogenarian patients treated with second-generation cobalt-chromium everolimus-eluting stents (CoCr-EES). In our series, 1-year safety and efficacy outcomes of CoCr-EES percutaneous coronary intervention in octogenarians were similar to those in younger counterparts.
在80岁及以上的患者中，与裸金属支架相比，使用第二代钴铬依维莫司洗脱支架（CoCr-EES）已被证明可降低心肌梗死（MI）和靶血管血运重建（TVR）率，且不会增加出血风险。然而，与年轻人群相比，CoCr-EES在八旬老人中的安全性和有效性尚不确定。我们旨在比较接受CoCr-EES经皮冠状动脉介入治疗（PCI）的八旬老人和非八旬老人的临床结局。
我们回顾性分析了186例接受CoCr-EES治疗的患者；54例八旬老人（63处病变）和132例非八旬老人（152处病变）。主要终点是全因死亡、MI、TVR、脑血管意外（CVA）或大出血的1年复合终点。还评估了支架血栓形成（ST）情况。
70.4%的八旬老人采用桡动脉入路，而非八旬老人为80.3%（p = 0.18）。1年时双联抗血小板治疗率在八旬老人中为90.7%，非八旬老人中为90.9%（p = 1.00）。主要终点在14.8%的八旬老人和11.4%的非八旬老人中出现（p = 0.52）。两组在1年全因死亡率（7.4%对3.8%，p = 0.30）、MI发生率（1.9%对1.5%，p = 1.00）、TVR发生率（3.7%对5.3%，p = 0.65）、CVA发生率（1.9%对2.3%，p = 1.00）以及明确/可能的ST发生率（1.9%对1.5%，p = 1.00）方面均无显著差异。仅1例八旬老人出现大出血。多因素分析表明，慢性肾脏病和血管内超声的使用是主要终点的唯一独立预测因素。
根据我们的系列研究，CoCr-EES PCI在八旬老人中的1年安全性和有效性结局与非八旬老人相当。
我们比较了接受第二代钴铬依维莫司洗脱支架（CoCr-EES）治疗的八旬老人和非八旬老人的临床结局。在我们的系列研究中，CoCr-EES经皮冠状动脉介入治疗在八旬老人中的1年安全性和有效性结局与年轻患者相似。
