Impact of Advanced Age on the Safety and Effectiveness of Paclitaxel-Eluting Stent Implantation in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Angioplasty: The HORIZONS-AMI Trial

ObjectivesTo assess the impact of age on safety and efficacy of paclitaxel-eluting stent (PES) implantation during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). BackgroundThe benefits of paclitaxel-eluting stent (PES) implantation during primary PCI were confirmed by the long-term results of the HORIZONS-AMI trial. Whether the effects of PES are independent of age has not been reported. MethodsData on 3,006 patients from the HORIZONS-AMI study randomized in a 3:1 ratio to PES or bare-metal stent (BMS) in whom at least one stent was implanted were assessed. There were 2,302 (76.6%) patients <70, and 704 patients 70 years of age. ResultsAt 3 years, among older patients a trend toward lower risk of major adverse cardiac events (MACE; death from any cause, stroke, reinfarction and unplanned revascularization for ischemia) related to PES use was observed (PES vs. BMS: 18.0% vs. 21.3%; P=0.07). There was also a trend for reduction of MACE related to PES in older patients (26.4% vs. 33.1%; P=0.09). Both, patients <70 and 70 years of age treated with PES were at lower risk for ischemic target vessel revascularization. However, a higher risk of major bleeding in elderly patients treated with PES was observed (P=0.02 for interaction between age group and PES effects). No interaction between age and stent type in terms of the risk of other clinical end points, including all-cause death, was confirmed. ConclusionsFor STEMI patients undergoing primary PCI, the implantation of PES as compared with BMS reduced ischemic TVR, and this effect was independent of age. [NCT00433966]. (c) 2013 Wiley Periodicals, Inc.