Liekom poťahované stenty a ich vplyv na zníženie počtu rehospitalizácii pri starších pacientoch

2.1.2012
Liekom poťahované stenty a ich vplyv na zníženie počtu rehospitalizácii pri starších pacientoch
Drug-Eluting Stents Lower Event Rates in Oldest Patients

Drug-Eluting Stents Lower Event Rates in Oldest Patients

By Kurt Ullman, Contributing Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

* Explain that declines in drug-eluting stent use in older patients undergoing percutaneous coronary intervention (PCI) were pronounced, despite lower adverse event rates associated with these stents versus bare-mental stents.
* Point out that rehospitalization for myocardial infarction was significantly lower in the drug-eluting stent group compared with the bare-mental group as age increased.

In the oldest of patients undergoing percutaneous coronary intervention, adverse-event rates were lower with drug-eluting stents than with bare-metal stents, researchers found, despite the fact that use of those stents declined significantly in that population. When compared with bare-metal stents, drug-eluting stents were associated with lower adjusted mortality risk in those 85 and older (29% versus 38%, adjusted HR=0.80, 95% CI 0.77 to 0.83), according to Tracy Y. Yang, MD, of Duke University, and colleagues. However, the adjusted mortality difference narrowed with increasing age (P<0.001 for interaction), they reported in the Journal of the American College of Cardiology.

Although the population of the U.S. is becoming older, there have been few studies that looked at the comparative effectiveness of drug-eluting versus bare-metal stents in those 85 years and older. This leads to uncertainty about the risk-benefit balance in this population that the researchers hoped to address in this study. The authors evaluated patients from the CathPCI Registry, the largest U.S. registry for patients undergoing PCI. The final study included 471,006 patients, ages 65 and up, from 947 sites who were successfully matched with Medicare fee-for-service data between 2004 and 2008. Long-term outcomes were compared between users of drug-eluting stents and bare-metal stents at a median follow-up of 640.8 days. However, rehospitalization for myocardial infarction was significantly lower in the drug-eluting stent group compared with the bare-metal group as age increased, coming in at 9% versus 12% for those ages 85 and up (HR=0.77, 95% CI 0.71 to 0.83). For those 75 to 84 years, the rates were 7% for drug-eluting stents versus 9% for bare-metal stents (HR=0.81, 95% CI 0.77 to 0.84). For those 65 to 74 years, the rates were 7% versus 8% (HR=0.84, 95% CI 0.80 to 0.88, P<0.001 for interaction).

Use of the drug-eluting stent was not associated with lower revascularization risk in the oldest age group, and bleeding risk was similar between the two stent types across all age groupings.

As this was an observational design, the authors noted that the association between treatments and outcome do not prove causality. Despite multivariate adjustments, there still may be unmeasured factors that skewed the benefit toward the drug-eluting stents.

Other study limitations included the use of claims data for event classification, which may have resulted in the increased risk of under-reporting or misclassification of risk. They also did not have access to longitudinal medicine use, which the researchers noted is key to the prevention of adverse outcomes over the long term.

"Several insights emerge from this study which represents, to the best of our knowledge, the largest report of PCI patients age ≥85 years to date," the authors wrote. First, an increasing proportion of PCIs is performed in patients ages 85 and up, they pointed out. Also, drug-eluting stent use has declined significantly since 2005, with the largest decrease in that older population.

Finally, drug-eluting stent use was associated with lower mortality and myocardial infarction risks across all older age groups without significant difference in repeat revascularization risk, they said.

Source: www.medpagetoday.com