TY - JOUR
T1 - A Prospective Randomized Trial of Everolimus-Eluting Stents Versus Bare-Metal Stents in Octogenarians
T2 - The XIMA Trial (Xience or Vision Stents for the Management of Angina in the Elderly)
AU - de Belder, Adam
AU - de la Torre Hernandez, Jose M.
AU - Lopez-Palop, Ramon
AU - O'Kane, Peter
AU - Hernandez Hernandez, Felipe
AU - Strange, Julian
AU - Gimeno, Federico
AU - Cotton, James
AU - Diaz Fernandez, Jose F.
AU - Carrillo Saez, Pilar
AU - Thomas, Martyn
AU - Pinar, Eduardo
AU - Curzen, Nick
AU - Baz, Jose A.
AU - Cooter, Nina
AU - Lozano, Inigo
AU - Skipper, Nicola
AU - Robinson, Derek
AU - Hildick-Smith, David
AU - XIMA Investigators
PY - 2014/4/15
Y1 - 2014/4/15
N2 - 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.
AB - 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.
KW - bare-metal stent(s)
KW - drug-eluting stent(s)
KW - octogenarians
KW - PERCUTANEOUS CORONARY INTERVENTION
KW - OUTCOMES
KW - REVASCULARIZATION
KW - DEFINITIONS
KW - THROMBOSIS
KW - CARDIOLOGY
KW - THERAPY
U2 - 10.1016/j.jacc.2013.10.053
DO - 10.1016/j.jacc.2013.10.053
M3 - Article
SN - 0735-1097
VL - 63
SP - 1371
EP - 1375
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 14
ER -