A prospective randomized trial of everolimus-eluting stents versus bare-metal stents in octogenarians: the XIMA Trial (Xience or Vision Stents for the Management of Angina in the Elderly)

de Belder, Adam de, de la Torre Hernandez, Jose M, Lopez-Palop, Ramon, O'Kane, Peter, Hernandez, Felipe Hernandez, Strange, Julian, Gimeno, Federico, Cotton, James, Fernandez, Jose F Diaz, Saez, Pilar Carrillo, Thomas, Martyn, Pinar, Eduardo, Curzen, Nick, Baz, Jose A, Cooter, Nina, Lozano, Inigo, Skipper, Nicola, Robinson, Derek, Hildick-Smith, David and XIMA Investigators, (2014) A prospective randomized trial of everolimus-eluting stents versus bare-metal stents in octogenarians: the XIMA Trial (Xience or Vision Stents for the Management of Angina in the Elderly). Journal of the American College of Cardiology, 63 (14). pp. 1371-1375. ISSN 0735-1097

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Abstract

Objectives
The aim of this study was to determine whether drug-eluting stents (DES) are superior to bare-metal stents (BMS) in octogenarian patients with angina.

Background
Patients ≥80 years of age frequently have complex coronary disease warranting DES but have a higher risk of bleeding from prolonged dual antiplatelet therapy.

Methods
This multicenter randomized trial was conducted in 22 centers in the United Kingdom and Spain. Patients ≥80 years of age underwent stent placement for angina. The primary endpoint was a 1-year composite of death, myocardial infarction, cerebrovascular accident, target vessel revascularization, or major hemorrhage.

Results
In total, 800 patients (83.5 ± 3.2 years of age) were randomized to BMS (n = 401) or DES (n = 399) for treatment of stable angina (32%) or acute coronary syndrome(68%). Procedural success did not differ between groups (97.7% for BMS vs. 95.4% for DES; p = 0.07). Thirty-eight percent of patients had ≥2-vessel percutaneous coronary intervention, and 66% underwent complete revascularization. Patients who received BMS had shorter stent implants (24.0 ± 13.4 mm vs. 26.6 ± 14.3 mm; p = 0.01). Rates of dual antiplatelet therapy at 1 year were 32.2% for patients in the BMS group and 94.0% for patients in the DES group. The primary endpoint occurred in 18.7% of patients in the BMS group versus 14.3% of patients in the DES group (p = 0.09). There was no difference in death (7.2% vs. 8.5%; p = 0.50), major hemorrhage (1.7% vs. 2.3%; p = 0.61), or cerebrovascular accident (1.2% vs. 1.5%; p = 0.77). Myocardial infarction (8.7% vs. 4.3%; p = 0.01) and target vessel revascularization (7.0% vs. 2.0%; p = 0.001) occurred more often in patients in the BMS group.

Conclusions
BMS and DES offer good clinical outcomes in this age group. DES were associated with a lower incidence of myocardial infarction and target vessel revascularization without increased incidence of major hemorrhage. (Xience or Vision Stent–Management of Angina in the Elderly [XIMA]; ISRCTN92243650)

Item Type: Article
Schools and Departments: School of Mathematical and Physical Sciences > Mathematics
Subjects: R Medicine > RD Surgery > RD0032 Operative surgery. Technique of surgical operations
Depositing User: Derek Robinson
Date Deposited: 26 Jun 2019 15:14
Last Modified: 04 Jul 2019 07:45
URI: http://sro.sussex.ac.uk/id/eprint/84603

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