Two-year outcomes after percutaneous coronary intervention with drug-eluting stents or bare-metal stents in elderly patients with coronary artery disease.

Giorgios Sideris, Olivier Varenne, Marie Claude Morice, Kris Bogaerts, Philippe Commeau, Josepa Mauri Ferre, Eduardo Pinar-Bermudez, José F Diaz Fernandez, Christian Spaulding, Philippe Garot, Thomas Hovasse, Stéphane Cook, Thomas Cuisset, Alexandre Lafont, Peter R Sinnaeve, Manel Sabate, Emmanuel Teiger, Salvatore Brugaletta, Gérard Helft, Rami El Mahmoud, Didier Carrié, Sasko Kedev

Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2021;97(5):E607-E613

PMID: 32761890

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Abstract

OBJECTIVES

Report the results at 2 years of the patients included in the SENIOR trial.

BACKGROUND

Patients above 75 years of age represent a fast-growing population in the cathlab. In the SENIOR trial, patients treated by percutaneous coronary intervention (PCI) with drug eluting stent (DES) and a short duration of P2Y12 inhibitor (1 and 6 months for stable and unstable coronary syndromes, respectively) compared with bare metal stents (BMS) was associated with a 29% reduction in the rate of all-cause mortality, myocardial infarction (MI), stroke, and ischaemia-driven target lesion revascularization (ID-TLR) at 1 year. The results at 2 years are reported here.

METHODS AND RESULTS

We randomly assigned 1,200 patients (596[50%] to the DES group and 604[50%] to the BMS group). At 2 years, the composite endpoint of all-cause mortality, MI, stroke and ID-TLR had occurred in 116 (20%) patients in the DES group and 131 (22%) patients in the BMS group (RR 0.90 [95%CI 0.72-1.13], p = .37). IDTLR occurred in 14 (2%) patients in the DES group and 41 (7%) patients in the BMS group (RR 0.35 [95%CI 0.16-0.60], p = .0002). Major bleedings (BARC 3-5) occurred in 27(5%) patients in both groups (RR 1.00, [95%CI 0.58-1.75], p = .99). Stent thrombosis rates were low and similar between DES and BMS (0.8 vs 1.3%, (RR 0.52 [95%CI 0.01-1.95], p = .27).

CONCLUSION

Among elderly PCI patients, a strategy combining a DES together with a short duration of DAPT is associated with a reduction in revascularization up to 2 years compared with BMS with very few late events and without any increased in bleeding complications or stent thrombosis.

Address: Cardiology Department Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and, Université de Paris, Paris, France.; Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.; Cardiology Department, Centre Hospitalier Universitaire Timone, Marseille, France.; Cardiology Department, University and Hospital Fribourg, Fribourg, Switzerland.; Cardiology Department Service de Cardiologie-Institut national de la santé et de la recherche médicale U942, Hôpital Lariboisiere, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France.; Cardiology Department, University St Cyril and Methodius, Skopje, Macedonia.; Service de Cardiologie, Centre hospitalier universitaire Toulouse Rangueil, Université Paul Sabatier, Toulouse, France.; Institut Cardiovasculaire Paris-Sud, Ramsay Générale de Santé, Massy, France.; Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint Quentin en Yvelines, Versailles, France.; Service de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris and Sudden Death Expert Center, Institut national de la santé et de la recherche médicale U990, Paris, France.; Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie et Institut hospitalo-universitaire, Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpétrière, Paris, France.; Cardiology department, Juan Ramón Jiménez University Hospital, Huelva, Spain.; Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.; Cardiology department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.; Cardiology department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.; Département de Cardiologie Interventionnelle, Polyclinique Les Fleurs, France.; Service de Cardiologie, Hôpital Henri Mondor Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France.; Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium, and Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), University Hasselt, Hasselt, Belgium.; Interventional Cardiology Unit, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.; CERC (Cardiovascular European Research Center), Massy, France.

DOI: 10.1002/ccd.29159

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MeSH Terms: Aged, Coronary Artery Disease, Drug-Eluting Stents, Humans, Percutaneous Coronary Intervention, Prosthesis Design, Risk Factors, Stents, Treatment Outcome