Drug-Eluting Versus Bare-Metal Stents in Older Patients: A Meta-Analysis of Randomized Controlled Trials |
| |
| Institution: | 1. Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI 48503, USA;2. Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA;3. Division of Hematology & Oncology, St. John Hospital, Grosse Pointe Woods, MI 48236, USA;4. Michigan State University, College of Human Medicine, Flint, MI 48502, USA;5. Brigham and Women''s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA 02115, USA;6. Research Assistance, Flint, MI 48503, USA;1. Sussex Cardiac Centre, Brighton and Sussex University Hospitals, BN2 5BE, UK;2. Brighton and Sussex Medical School, BN1 9PX, UK;1. New York University School of Medicine, New York, NY, USA;2. Department of Cardiology, L.R.G. Naidu Cardiology Research Institute and Clinic, Kuppuswamy Naidu Memorial Hospital, Coimbatore, India;3. Department of Cardiology, The Madras Medical Mission, Chennai, India;4. Department of Cardiology, Sir Ganga Ram Hospitals, New Delhi, India;5. Department of Cardiology, Krishna Institute of Medical Sciences, Secunderabad, India;6. Batra Hospital and Medical Research Center, New Delhi, India;1. Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI 48503, USA;2. Department of Internal Medicine, Mutah University, Al-Karak, Jordan;3. Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD 21229, USA;4. Division of Cardiology, Hurley Medical Center/Michigan State University, Flint, MI 48503, USA;1. Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois;2. Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan;3. Department of Cardiology, Cleveland Clinic, Cleveland, Ohio;4. Department of Cardiology, University of Louisville, Louisville, Kentucky;5. Evidence-Based Practice Center, Mayo Clinic, Rochester, New York;6. Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio;7. Department of Cardiology, Institute for Heart & Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania;8. Department of Medicine, Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania;9. Department of Cardiology, Brigham and Women''s Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts;1. Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon;2. Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia;3. Midwest Cardiovascular Research Foundation, Davenport, Iowa |
| |
| Abstract: | BackgroundDespite the high prevalence of ischemic heart disease in older patients, there is a substantial lack of evidence to guide clinical decision-making in this population. Hence, we performed a meta-analysis to determine the safety and efficacy of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus bare-metal stents (BMS).MethodsElectronic databases were searched for randomized trials comparing DES with BMS in patients ≥70 years-old. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included different ischemic and bleeding events. Subgroup analyses for dual-antiplatelet therapy (DAPT) duration were conducted.ResultsWe included 7 trials with a total of 5449 patients. The use of DES compared with BMS was associated with a significant reduction in MACE (odds ratio OR]:0.76; 95% confidence interval CI]:0.62–0.93; P = 0.007) with no increased risk of bleeding events (OR: 1.07; 95% CI: 0.89–1.27; P = 0.48). However, longer duration of DAPT (>6 months) for the DES group increased bleeding events (OR: 1.52; 95% CI: 1.05–2.20; P = 0.03). In contrast, shorter DAPT showed persistent efficacy in reducing MACE in DES-treated patients with no increased bleeding events (OR: 0.72; 95% CI: 0.60–0.87; P < 0.01 and OR: 1.01; 95% CI: 0.84–1.22; P = 0.89, respectively).ConclusionsIn older patients who had undergone PCI, DES showed superior efficacy in reducing MACE with no increased risk of bleeding compared with BMS. Persistent MACE reduction was evident with shorter DAPT durations in DES-treated patients.SummaryThis meta-analysis of randomized clinical trials demonstrated that drug-eluting stents were associated with a significant reduction in major adverse cardiovascular events with no increased risk of bleeding compared with bare-metal stents. The risk of bleeding was high with longer dual antiplatelet therapy duration for patients who underwent DES placement. However, short duration of dual antiplatelet therapy substantially reduced major adverse cardiovascular events with no increased bleeding risk. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
