Efficacy of Percutaneous Coronary Intervention With Synergy Stents in Patients Aged ≥75 Years: 1-Year Clinical Outcomes from the Synergy Elderly Registry

• Published in: The American journal of cardiology Vol. 204; pp. 43 - 52
• Main Authors: Park, Jong-Il, Lee, Seung-Jun, Hong, Young-Joon, Yoo, Sang-Yong, Seo, Yong-Sung, Im, Eui, Park, Jong-Kwan, Lee, Jin-Bae, Lee, Yong-Joon, Hong, Sung-Jin, Ahn, Chul-Min, Kim, Jung-Sun, Ko, Young-Guk, Choi, Donghoon, Hong, Myeong-Ki, Kim, Byeong-Keuk
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2023; Elsevier Limited
• Subjects: aging; Anemia; Angioplasty; Blood vessels; Cardiovascular disease; Cerebral infarction; Clinical outcomes; Complexity; Consortia; coronary artery disease; Coronary vessels; Death; Diabetes; Diabetes mellitus; Drug delivery; drug-eluting stents; Heart; Heart failure; Hemoglobin; Implantation; Implants; Ischemia; Kidney diseases; Myocardial infarction; Occlusion; Older people; percutaneous coronary intervention; Stents; Stroke; Surgery; Surgical implants; Survival analysis; Thromboembolism; Thrombosis; Vein & artery diseases; Ventricle; coronary artery disease; percutaneous coronary intervention; drug-eluting stents; aging
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2023.07.094

Data regarding the clinical outcomes of older patients after Synergy everolimus-eluting stent (S-EES) implantation are limited. This study investigated the 12-month clinical outcomes of older patients who underwent percutaneous coronary intervention with new-generation drug-eluting stents according to ischemic risks. This prospective multicenter study targeted patients aged ≥75 years who underwent S-EES implantation. The primary and secondary end points included 12-month device-oriented composite end point (DOCE) (cardiovascular death, target vessel myocardial infarction, or target lesion revascularization) and major adverse cardiac and cerebrovascular events (MACCEs; all-cause death, myocardial infarction, target vessel revascularization, stent thrombosis, or stroke), respectively. A stratified analysis was conducted according to high-ischemic risk (HIR), defined as complex coronary intervention (number of stents implanted ≥3, total stented length >60 mm, chronic total occlusion, left main, or bifurcation), diabetes, or chronic kidney disease. In total, 650 enrolled patients aged ≥75 years were categorized into HIR (n = 425) and non-HIR groups (n = 225). In the total population, the 1-year incidence of DOCEs was 2.5%. The rates of DOCEs were not significantly different between the HIR and the non-HIR groups, whereas the MACCE rate was higher in the HIR (9.4%) than the non-HIR group (4.9%, p = 0.035), and the DOCE and MACCE components did not differ significantly in the occurrence between the groups. The independent predictors for the DOCEs or MACCEs included age, anemia, or left ventricular ejection fraction <40%. In conclusion, in older patients, S-EES implantation demonstrated favorable device-related outcomes, regardless of procedural complexity or co-morbidities. However, it requires careful attention because older patients with HIR are associated with worse clinical outcomes.