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Drug-Eluting Versus Bare-Metal Stents in Older Patients: A Meta-Analysis of Randomized Controlled Trials.

Publication ,  Journal Article
Kheiri, B; Osman, M; Abdalla, A; Haykal, T; Chahine, A; Gwinn, M; Ahmed, S; Hassan, M; Bachuwa, G; Bhatt, DL
Published in: Cardiovascular revascularization medicine : including molecular interventions
September 2019

Despite 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).Electronic 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.We 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).In 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.This 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.

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Published In

Cardiovascular revascularization medicine : including molecular interventions

DOI

EISSN

1878-0938

ISSN

1553-8389

Publication Date

September 2019

Volume

20

Issue

9

Start / End Page

744 / 751

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Stents
  • Risk Factors
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Prosthesis Design
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Metals
 

Citation

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Kheiri, B., Osman, M., Abdalla, A., Haykal, T., Chahine, A., Gwinn, M., … Bhatt, D. L. (2019). Drug-Eluting Versus Bare-Metal Stents in Older Patients: A Meta-Analysis of Randomized Controlled Trials. Cardiovascular Revascularization Medicine : Including Molecular Interventions, 20(9), 744–751. https://doi.org/10.1016/j.carrev.2018.11.005
Kheiri, Babikir, Mohammed Osman, Ahmed Abdalla, Tarek Haykal, Adam Chahine, Meghan Gwinn, Sahar Ahmed, Mustafa Hassan, Ghassan Bachuwa, and Deepak L. Bhatt. “Drug-Eluting Versus Bare-Metal Stents in Older Patients: A Meta-Analysis of Randomized Controlled Trials.Cardiovascular Revascularization Medicine : Including Molecular Interventions 20, no. 9 (September 2019): 744–51. https://doi.org/10.1016/j.carrev.2018.11.005.
Kheiri B, Osman M, Abdalla A, Haykal T, Chahine A, Gwinn M, et al. Drug-Eluting Versus Bare-Metal Stents in Older Patients: A Meta-Analysis of Randomized Controlled Trials. Cardiovascular revascularization medicine : including molecular interventions. 2019 Sep;20(9):744–51.
Kheiri, Babikir, et al. “Drug-Eluting Versus Bare-Metal Stents in Older Patients: A Meta-Analysis of Randomized Controlled Trials.Cardiovascular Revascularization Medicine : Including Molecular Interventions, vol. 20, no. 9, Sept. 2019, pp. 744–51. Epmc, doi:10.1016/j.carrev.2018.11.005.
Kheiri B, Osman M, Abdalla A, Haykal T, Chahine A, Gwinn M, Ahmed S, Hassan M, Bachuwa G, Bhatt DL. Drug-Eluting Versus Bare-Metal Stents in Older Patients: A Meta-Analysis of Randomized Controlled Trials. Cardiovascular revascularization medicine : including molecular interventions. 2019 Sep;20(9):744–751.
Journal cover image

Published In

Cardiovascular revascularization medicine : including molecular interventions

DOI

EISSN

1878-0938

ISSN

1553-8389

Publication Date

September 2019

Volume

20

Issue

9

Start / End Page

744 / 751

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Stents
  • Risk Factors
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Prosthesis Design
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Metals