Age is not a bar to PCI: Insights from the long‐term outcomes from off‐site PCI in a real‐world setting

Abstract

This study demonstrates an acceptable occurrence of MI, death, repeat intervention, and stent thrombosis in a high-risk group of V. Eld. patients with de novo lesions. Age alone in the absence of other non-cardiac factors should not prohibit a patient from access to PCI.

Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials

“…This improvement, however, increased the prevalence of bleeding complications due to use of DES and longer duration of dual antiplatelet therapy (DAPT), compared to that using bare-metal stents (BMS) [6]. Long duration of DAPT after DES deployment was associated with higher risk of major bleeding complications despite the beneficial effects of novel platforms, especially in vulnerable populations such as patients over 75 years old [7].…”

Use of drug‐eluting stents in elderly patients with acute myocardial infarction

“…Early generation DES have now been supplanted by new‐generation DES with higher efficacy and safety in comparison with both early generation DES and BMS 14 . However, in several countries elderly patients still frequently receive BMS with the intent to shorten the duration of DAPT, to reduce bleeding complications 2 . Though, the 2018 European guidelines on myocardial revascularisation recommend DES over BMS for any percutaneous coronary intervention (PCI) and the use of BMS is decreasing in developed countries, BMS use still accounts for approximately 20% of all PCI procedures in the USA 14‐16 .…”

“…Compared with DES, the time required for the development of the endothelial coverage is shorter, thus the risk of suspension of double antiplatelet therapy (DAPT) may be lower with bare‐metal stents (BMS) 1 . Elderly patients have a higher bleeding risk and this may lead to the use of BMS during coronary interventions 2 . In line with several trials the recent “Short Duration of Dual antiplatElet Therapy With SyNergy II Stent in Patients Older Than 75 Years Undergoing Percutaneous Coronary Revascularization” (SENIOR) trial found that among elderly patients, the use of DES with a short duration of DAPT strategy is beneficial compared with BMS and a similar duration of DAPT.…”

Combinations of bleeding and ischemic risk and their association with clinical outcomes in acute coronary syndrome

“…Current treatment strategies for this dual high-risk group are based on clinicians' experience and involve the preferential use of clopidogrel over more potent P2Y12 inhibitors owing to its association with lower non-access related bleeding and the use of drug-coated (DCS) or bare metal stents (BMS) as opposed to drug eluting stents. [26,27] However, a recent meta-analysis demonstrated no difference in bleeding events between Clopidogrel and newer P2Y12 inhibitors in both elderly and non-elderly patients. [28] Furthermore, there has been no head-to-head comparison of adverse cardiac events and bleeding between DES and DCS in this dual high-risk group to date.…”