Impact of Age on Long-Term Outcome After Primary Angioplasty With Bare-Metal or Drug-Eluting Stent (from the DESERT Cooperation)

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• 作者：Giuseppe De Luca ; Maurits T. Dirksen ; Christian Spaulding ; Henning Kelb?k ; Martin Schalij ; Leif Thuesen ; Bas van der Hoeven ; Marteen A. Vink ; Christoph Kaiser ; Carmine Musto ; Tania Chechi ; Gaia Spaziani ; Luis Salvador Diaz de la Llera ; Vincenzo Pasceri ; Emilio Di Lorenzo ; Roberto Violini ; Harry Suryapranata ; Gregg W. Stone ; DESERT cooperation
• 刊名：The American Journal of Cardiology
• 出版年：2013
• 出版时间：15 July, 2013
• 年：2013
• 卷：112
• 期：2
• 页码：181-186
• 全文大小：611 K

文摘

Despite mechanical reperfusion, elderly patients with ST-segment elevation myocardial infarction (STEMI) still experience unsatisfactory outcomes. Drug-eluting stents (DES) have significantly reduced target-vessel revascularization (TVR), but concerns have emerged about the higher risk of late stent thrombosis, which may be more pronounced in elderly patients. Therefore, the aim of this study was to evaluate the impact of age on outcome in patients with STEMI who underwent primary angioplasty with bare-metal stents (BMS) or DES. Our population comprised 6,298 patients who underwent primary angioplasty and stent implantation included in the Drug-Eluting Stent in Primary Angioplasty (DESERT) Cooperation database. Age was significantly associated with female gender (p <0.001), diabetes (p <0.001), hypertension (p <0.001), previous myocardial infarction (MI; p <0.001), ischemia time (p <0.001), and anterior MI (p <0.001) but inversely related to smoking (p <0.001). Elderly patients most often had infarct-related artery located in the descending artery (p?= 0.014) and impaired postprocedural thrombolysis in myocardial infarction flow (p <0.001). Elderly patients were less often on clopidogrel at follow-up. At long-term follow-up, age was associated with a higher rate of death (hazard ratio [95 % confidence interval]?= 2.17 [1.97 to 2.39], p <0.0001), whereas no impact was observed on reinfarction (p?= 0.36), stent thrombosis (p?= 0.84), and TVR (p?= 0.54). These results were confirmed in patients receiving both BMS and DES. The impact of age on mortality was confirmed after correction for baseline confounding factors (gender, diabetes hypertension, hypercholesterolemia, smoking, ischemia time, anterior MI, infarct-related artery location, and postprocedural thrombolysis in myocardial infarction 3?flow; adjusted hazard ratio [95 % confidence interval]?= 2.13 [1.78 to 2.56], p <0.001). In?conclusion, this study shows that in patients with STEMI who underwent primary angioplasty, age is independently associated with higher mortality, observed with both BMS and DES, whereas no impact was observed on the rate of reinfarction, stent thrombosis, and TVR.