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| The Use of CYPHER SELECT Plus Sirolimus-Eluting Coronary Stent in Octogenarian Patients – A Report From the e-Select Registry at 1-Year Follow-Up |
| 1전남대학교병원, 2Instituto Dante Pazzanese de Cardiologia, Sao Paolo, Brazil, 3John Radcliffe Hospital, Oxford, UK, 4Centro Cardiologico Monzino, University of Milan, Milan, Italy, 5University Health Network, Toronto, Canada, 6Cleveland Clinic Foundation, Cleveland, USA, 7Cardiovascular Institute Fu Wai Hospital, Beijing, China, 8Mayo Clinic, Rochester, MN, USA, 9Université Catholique de Louvain, Saint- |
| 홍영준1, 정명호1, Alexander Abizaid2, Adrian Banning3, Antonio Bartorelli4, Vladimir Dzavik5, Stephan G. Ellis6, Runlin Gao7, David Holmes8, Victor Legrand9, Franz-Josef Neumann10, Maria Nyakern11, Christian Spaulding12, Stephen Worthley13, and other e-Select Registry Investigators |
Background: There is controversy over which strategy we should take in octogenarian patients after placement of drug-eluting stent (DES). Methods and Results: Between 2006 and 2008, 15,147 patients from 320 hospitals in 56 countries were enrolled in a registry after the successful implantation of at least one Cypher Select® or Cypher Select® Plus sirolimus-eluting stent (SES), follow-up information obtained at 1-year in 675 octogenarian patients were compared with those in 14,472 non-octogenarian patients. Octogenarians had markedly more co-morbidities including hypertension, peripheral and cerebrovascular diseases, congestive heart failure, and renal dysfunction, and had higher Charlson co-morbidity index score (1.45±1.6 vs. 1.03±1.3, P<0.001) compared with non-octogenarians. There were more bypass graft lesion (4.4% vs. 1.7%, P<0.001), restenotic lesion (16.3% vs. 11.6%, P<0.001), and heavily calcified lesion (8.6% vs. 3.8%, P<0.001) in octogenarians, and multiple stents were used (23.7% vs. 19.0%, P=0.003) in octogenarian group. At 1-year follow-up, dual anti-platelet agents were continued in 73% in octogenarian group and in 80% in non-octogenarian group (P<0.001). At 1-year, composite of death, myocardial infarction, and target lesion revascularization (9.1% vs. 4.6%, P<0.001), definite or probable stent thromboses (2.3% vs. 0.9%, P=0.002), and major bleeding complications (2.0% vs. 0.9%, P=0.015) were observed more frequently in octogenarian group. Interestingly all stent thrombosis occurred during first 6-month after index procedure in octogenarian group and there were no significant differences in rate of target lesion revascularization between the two groups. In octogenarians, Charlson comorbidity index was independent predictor of any death and stent thrombosis up to 360 days from the index procedure [Hazard ratio (HR): 1.3, 95% confidence interval (CI): 1.1-1.5, P<0.001, and HR: 1.5, 95% CI: 1.3-1.8, P<0.001, respectively). Conclusions: SES may be an effective therapeutic option in octogenarian patients with acceptable rates of complications and a very low rate of repeat revascularization as demonstrated by this e-Select registry subgroup analysis.
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