Author + information
- Received July 11, 2013
- Revision received October 1, 2013
- Accepted October 8, 2013
- Published online April 15, 2014.
- Adam de Belder, MD∗∗ (, )
- Jose M. de la Torre Hernandez, MD, PhD†,
- Ramon Lopez-Palop, PhD‡,
- Peter O'Kane, MD§,
- Felipe Hernandez Hernandez, MD‖,
- Julian Strange, MD¶,
- Federico Gimeno, PhD#,
- James Cotton, MD∗∗,
- Jose F. Diaz Fernandez, MD††,
- Pilar Carrillo Saez, PhD‡,
- Martyn Thomas, MD‡‡,
- Eduardo Pinar, PhD§§,
- Nick Curzen, PhD‖‖,
- Jose A. Baz, MD¶¶,
- Nina Cooter, RCN∗,
- Inigo Lozano, PhD##,
- Nicola Skipper, RCN∗,
- Derek Robinson, PhD∗∗∗,
- David Hildick-Smith, MD∗,
- XIMA Investigators
- ∗Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England
- †Hospital Marqués de Valdecilla, Santander, Spain
- ‡Hospital San Juan de Alicante, Alicante, Spain
- §Royal Bournemouth Hospital, Bournemouth, England
- ‖Hospital 12 de Octubre, Madrid, Spain
- ¶Bristol Royal Infirmary, Bristol, England
- #Hospital Clínico de Valladolid, Valladolid, Spain
- ∗∗Royal Wolverhampton Hospital, Wolverhampton, England
- ††Hospital Juan Ramón Jiménez, Huelva, Spain
- ‡‡St Thomas' Hospital, London, England
- §§Hospital Virgen de la Arrixaca, Murcia, Spain
- ‖‖Southampton University Hospitals National Health Service Trust, Southampton, England
- ¶¶Hospital Meixoeiro, Vigo, Spain
- ##Hospital Central de Asturias, Oviedo, Spain
- ∗∗∗Department of Mathematics, University of Sussex, East Sussex, England
- ↵∗Reprint requests and correspondence:
Dr. Adam de Belder, Department of Cardiology, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, England.
Objectives The aim of this study was to determine whether drug-eluting stents (DES) are superior to bare-metal stents (BMS) in octogenarian patients with angina.
Background Patients ≥80 years of age frequently have complex coronary disease warranting DES but have a higher risk of bleeding from prolonged dual antiplatelet therapy.
Methods This multicenter randomized trial was conducted in 22 centers in the United Kingdom and Spain. Patients ≥80 years of age underwent stent placement for angina. The primary endpoint was a 1-year composite of death, myocardial infarction, cerebrovascular accident, target vessel revascularization, or major hemorrhage.
Results In total, 800 patients (83.5 ± 3.2 years of age) were randomized to BMS (n = 401) or DES (n = 399) for treatment of stable angina (32%) or acute coronary syndrome (68%). Procedural success did not differ between groups (97.7% for BMS vs. 95.4% for DES; p = 0.07). Thirty-eight percent of patients had ≥2-vessel percutaneous coronary intervention, and 66% underwent complete revascularization. Patients who received BMS had shorter stent implants (24.0 ± 13.4 mm vs. 26.6 ± 14.3 mm; p = 0.01). Rates of dual antiplatelet therapy at 1 year were 32.2% for patients in the BMS group and 94.0% for patients in the DES group. The primary endpoint occurred in 18.7% of patients in the BMS group versus 14.3% of patients in the DES group (p = 0.09). There was no difference in death (7.2% vs. 8.5%; p = 0.50), major hemorrhage (1.7% vs. 2.3%; p = 0.61), or cerebrovascular accident (1.2% vs. 1.5%; p = 0.77). Myocardial infarction (8.7% vs. 4.3%; p = 0.01) and target vessel revascularization (7.0% vs. 2.0%; p = 0.001) occurred more often in patients in the BMS group.
Conclusions BMS and DES offer good clinical outcomes in this age group. DES were associated with a lower incidence of myocardial infarction and target vessel revascularization without increased incidence of major hemorrhage. (Xience or Vision Stent–Management of Angina in the Elderly [XIMA]; ISRCTN92243650)
This study was endorsed by the Spanish Working Group on Interventional Cardiology and was funded by an unrestricted educational grant from Abbott Vascular. Dr. de la Torre Hernandez has served as an advisory board member for Boston Scientific, Medtronic, and Biotronik; and has received speaker fees from Volcano Corp., St. Jude Medical, Boston Scientific, AstraZeneca, and Eli Lilly and Company. Dr. O'Kane has served as a proctor for Biosensors and Spectranetics. Dr. Curzen has received unrestricted grants from Haemonetics, St. Jude Medical, and Medtronic; and has served as a speaker and consultant for Haemonetics, St. Jude Medical, Boston Scientific, Daiichi Sankyo, and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 11, 2013.
- Revision received October 1, 2013.
- Accepted October 8, 2013.
- American College of Cardiology Foundation