Patients with Age over 70 and 80 years in the Worldwide e-HEALING Registry A High Risk Population with Favourable Outcome after Genous Stent¢â Implantation
1Hospital Universitario de Vigo, Vigo, Spain; 2Kardiologische Praxis und Praxisklinik, Munich, Germany; 3Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; 4Klinische Abteilung fur Kardiologie, Graz, Austria; 5, The Heart Institute of the University of São Paulo, Sao Paulo, Brazil; 6Isala Klinieken, Hospital De Weezenlanden, Zwolle, Netherlands; 7Medical University of Lublin, Lublin, Poland; 8Sarawak General Hospital, Sarawak, Malaysia
A. Iniguez1, S. Silber2, R.J. DeWinter3, M. Grisold4, E.E. Ribeiro5, H. Suryapranata6, J. Wojcik7, K.H. Sim8
Background: The e-HEALING registry is an prospective observational trial designed to capture real world data on the use of the Genous EPC (Endothelial Progenitor Cells) capture R stent¢â). Elderly patients (P) revascularized by coronary angioplasty (PCI) constitutes a high risk subgroup of P for bleeding events with the use of long-term dual antiplatelet therapy. Even more the need of suppression of antiplatelet treatment due to co-morbidities or for non-coronary surgery after stent implantation may increase the risk of stent thrombosis. Here we report the outcome of P with age over 70 years included in the e-HEALING Registry. Data of P with age over 80 years will be available at a later stage, before TCT AP.
Methods: From a total of 4,996 patients included in the e-HEALING Registry, 1416 P (1954 lesions) were over 70 years old, representing 28,3 % of the full trial population All P had at least one coronary artery lesion suitable for stenting with a 2.5-4.0mm diameter Genous stent in stent lengths 9-33mm. One month of dual antiplatelet therapy after PCI was recommended. Clinical follow-up was at 1, 6 and 12 months. All MACEs (Major Adverse Cardiac Event, defined as cardiac death, myocardial infarction (MI) or clinically driven target lesion revascularization (TLR)), were adjudicated by an independent committee.
Results: Mean age was 76.6 ¡¾ 4.3 years old. Female were 32.8 % of P, 70.2 % of P were on statin use at least 2 weeks before PCI, 25.5 % of P were diabetics (6.4 % insulin dependent), 71.7 % had hypercholesterolemia and 76.6 % hypertension. Previous MI were in 39.2 % of P, previous PCI in 20.3 % of P. PCI indication was unstable angina in 22.2 % of P. A mean of 1.6 ¡¾ 0.9 stent per P were implanted, in a mean of 1.4 ¡¾ 0.7 lesions per P. Mean length of lesions was 16.3 ¡¾ 8.4 mm in reference vessel diameter of 3.0 ¡¾ 0.4 mm. Lesions classification were as follows: Type A (10.6 %), B1 (34.3 %), B2 (35.0 %), C (20.1 %). Moderate or severe calcification was present in 35.5 % of lesions. MACE rate up to discharge was as follow: cardiac death (0.6 %), MI (1.1 %), TLR (0.1 %). At 1 year follow-up (FU) there were 1279 P (90.3 %) MACE event free. MACE rate up to 1 year were: cardiac death (41 P)(2.9 %), MI (25 P)(1.8 %), TRL PCI (65 P)(4.6 %), TLR Coronary Artery Bypass Graft (6 P)(0.4 %). At 1 year FU, Stent Thrombosis was observed in 16 P (1.1 %) (acute in 0.2 %, subacute in 0.4% and late in 0.6 %)(definite in 0.7 %, probable in 0.9 % and possible in 1.6 %).
Conclusion: Patients over 70 years old treated with the Genous EPC stent have a good one-year clinical outcome despite an associated unfavourable baseline clinical and anatomical risk profile.