Author + information
- Received August 1, 2011
- Revision received September 20, 2011
- Accepted October 11, 2011
- Published online January 10, 2012.
- Tracy Y. Wang, MD, MHS, MSc⁎,⁎ (, )
- Frederick A. Masoudi, MD, MSPH†,
- John C. Messenger, MD†,
- Kendrick A. Shunk, MD, PhD‡,
- Andrew Boyle, PhD, MBBS‡,
- J. Matthew Brennan, MD, MPH⁎,
- H. Vernon Anderson, MD§,
- Kevin J. Anstrom, PhD⁎,
- David Dai, PhD⁎,
- Eric D. Peterson, MD, MPH⁎,
- Pamela S. Douglas, MD⁎ and
- John S. Rumsfeld, MD, PhD∥
- ↵⁎Reprint requests and correspondence:
Dr. Tracy Y. Wang, Duke Clinical Research Institute, 2400 Pratt Street, Durham, North Carolina 27705
Objectives This study assessed the comparative effectiveness of drug-eluting stents (DES) versus bare-metal stents (BMS) among patients ≥85 years of age.
Background Despite an aging population, little is known about the comparative effectiveness of DES versus BMS among patients age ≥85 years undergoing percutaneous coronary intervention (PCI).
Methods We examined 471,006 PCI patients age ≥65 years at 947 hospitals in the National Cardiovascular Data Registry between 2004 and 2008 and linked to Medicare claims data. Long-term outcomes (median follow-up 640.8 ± 423.5 days) were compared between users of DES and BMS.
Results Patients age ≥85 years comprise an increasing proportion of PCIs performed among elderly subjects, yet rates of DES use declined the most in this age group. Compared with BMS, use of DES was associated with lower mortality: age ≥85 years, 29% versus 38% (adjusted hazard ratio [HR]: 0.80 [95% confidence interval (CI): 0.77 to 0.83]); age 75 to 84 years, 17% versus 25% (HR: 0.77 [95% CI: 0.75 to 0.79]); and age 65 to 74 years, 10% versus 16% (HR: 0.73 [95% CI: 0.71 to 0.75]). However, the adjusted mortality difference narrowed with increasing age (pinteraction <0.001). In contrast, the adjusted HR for myocardial infarction rehospitalization associated with DES use was significantly lower with increasing age: age ≥85 years, 9% versus 12% (HR: 0.77 [95% CI: 0.71 to 0.83]); age 75 to 84 years, 7% versus 9% (HR: 0.81 [95% CI: 0.77 to 0.84]); and age 65 to 74 years, 7% versus 8% (HR: 0.84 [95% CI: 0.80 to 0.88]) (pinteraction <0.001).
Conclusions In this national study of older patients undergoing PCI, declines in DES use were most pronounced among those aged ≥85 years, yet lower adverse-event rates associated with DES versus BMS use were observed.
This project was sponsored by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, as part of the Cardiovascular Consortium (Project ID: 24-EHC-1, Work Assignment Number: HHSAA290-2005-0032–TO4-WA1, Developing Evidence to Inform Decisions about Effectiveness program). The authors of this paper are responsible for its content, and statements in the paper should not be construed as endorsement by the Agency for Healthcare Research and Quality or the Department of Health and Human Services. Additional support was obtained from the American College of Cardiology National Cardiovascular Data Registry. Dr. Wang has received research grants (to the Duke Clinical Research Institute) from Bristol-Myers Squibb/Sanofi Aventis Partnership, Schering-Plough/Merck & Co., Inc., The Medicines Company, Heartscape Technologies, Inc., Canyon Pharmaceuticals, and Eli Lilly and Company/Daiichi Sankyo alliance; and consulting or honoraria from Medco Health Solutions, Inc., and AstraZeneca. Dr. Masoudi has received salary support from the American College of Cardiology; is senior medical officer for the National Cardiovascular Data Registry (significant); and is a consultant for the Oklahoma Foundation for Medical Quality. Dr. Anstrom has received research and salary support from Alexion Pharmaceuticals, AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Company, Innocoll Pharmaceuticals, Medtronic, Pfizer Inc., and Proctor & Gamble (modest); serves on the data safety monitoring boards of Pfizer Inc. and Vertex Pharmaceuticals (modest); and provides consulting services to Pacific Therapeutics Ltd., Bristol-Myers Squibb, and AstraZeneca (modest). Dr. Peterson has received research support from Bristol-Myers Squibb/Sanofi Aventis Partnership, Merck & Co., Inc., Johnson & Johnson, and Eli Lilly and Company (all significant). Dr. Rumsfeld is the chief science officer for the National Cardiovascular Data Registry. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 1, 2011.
- Revision received September 20, 2011.
- Accepted October 11, 2011.
- American College of Cardiology Foundation