Impact of advanced age on the safety and effectiveness of paclitaxel-eluting stent implantation in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: The HORIZONS-AMI trial.

Abstract

OBJECTIVES:

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).

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

For STEMI patients undergoing primary PCI, the implantation of PES as compared with BMS reduced ischemic TVR, and this effect was independent of age.

• Authors: Dariusz Dudek, Roxana Mehran, Artur Dziewierz, Bernhard Witzenbichler, Bruce R Brodie, Ran Kornowski, Martin Fahy, Alexandra J Lansky, Tomasz Rakowski, Jacek Legutko, Leszek Bryniarski, Gregg W Stone
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 82 Issue 6 Pg. 869-77 (Nov 15 2013) ISSN: 1522-726X [Electronic] United States
• PMID: 23359554 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Wiley Periodicals, Inc.

Chemical References

• Cardiovascular Agents
• Paclitaxel

Topics

• Age Factors
• Aged
• Angioplasty, Balloon, Coronary (adverse effects, instrumentation, mortality)
• Cardiovascular Agents (administration & dosage)
• Disease-Free Survival
• Drug-Eluting Stents
• Female
• Hemorrhage (etiology)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, mortality, therapy)
• Paclitaxel (administration & dosage)
• Recurrence
• Risk Factors
• Stroke (etiology)
• Time Factors
• Treatment Outcome