Drug-Coated Stents Are Effective For Elderly
Stents coated with the drug paclitaxel may be a safe, effective treatment option for coronary artery disease (CAD) patients age 70 and older and shouldn’t be withheld due to advanced patient age, according to a study reported in Circulation: Cardiovascular Interventions.
The study of nearly 10,000 patients in randomized clinical trials and “real world” registries found that:
* Even though patients older than 70 years had significantly more risk factors (such as congestive heart failure, high blood pressure, kidney disease, prior stroke or transient ischemic attacks and prior bypass surgery), their rates of heart attack, stent thrombosis and repeat treatment during follow-up were similar to those of younger clinical trial patients.
* While the annual rate of death was significantly higher in the older patients compared to younger patients in the trials and registries, the death rates in the older patients in the randomized trials were similar to people of like ages in the general U.S. population.
* Most outcomes were similar between elderly patients treated with a bare-metal stent or a paclitaxel-eluting stent; however, patients treated with drug-eluting stents had a 54 percent lower need for repeat treatments than did patients treated with bare-metal stents.
“The outcomes of drug-eluting stents in elderly patients who are fundamentally at higher risk due to increased prevalence of co-existing conditions as well as more complex and extensive atherosclerosis remain poorly studied,” said Daniel E. Forman, M.D., lead author of the study and director of cardiac rehabilitation and the exercise testing laboratory at Brigham and Women’s Hospital in Boston, Mass. “In the absence of age-specific data, some physicians avoid drug-eluting stents in elderly patients, potentially depriving them of what may be a more beneficial treatment alternative.”
A stent is a wire-mesh metal tube that’s inserted into an artery during percutaneous coronary intervention procedures to prop open an artery. Some stents are coated with drugs that are slowly released and help keep the blood vessel from reclosing.
While drug-eluting stents have become the mainstay of coronary stenting for treating CAD, data on their use in elderly patients is limited. Researchers reviewed data on 2,271 patients who received paclitaxel-eluting stents in one of five stent randomized clinical trials and 7,492 more complex “real world” patients who received paclitaxel-eluting stents in one of two stent registries.
The “real world” data was important, “since clinical trials typically enroll healthier patients,” Forman said.
Researchers divided patients into three groups according to age: younger than 60 years; 60 to 70 years; and older than 70 years. They then compared the annual risk of death, heart attack, stent thrombosis (blood clot) and need for repeat treatment among these three age groups up to five years after having coronary stenting to determine if advancing age had an effect on these outcomes.
“The elderly constitute an expanding population segment, and since the risk of CAD increases with age, the number of elderly patients seeking treatment is on the rise,” Forman said. “Advanced age alone should not be taken as a contraindication to percutaneous intervention using paclitaxel-eluting stents in elderly patients.”
Researchers said the result may not apply to other drug-eluting stents.
“This study extends our knowledge about drug-eluting stent outcomes in the aged population, and demonstrates that the paclitaxel-eluting stent is as safe in elderly patients who have indications for invasive treatment, as in their younger counterparts.”