GERMANY: Elderly Too Benefit From Newer Heart Stents

NEW YORK (Reuters Health), November 28, 2007: Stents coated with the drug sirolimus are safe and effective for treating elderly heart patients with blocked coronary arteries, according to a new report. For elderly patients undergoing angioplasty with insertion of stents to prop open their coronary arteries, the risks are 2- to 4-fold higher than for younger patients, the authors explain in the American Heart Journal. The so-call sirolimus-eluting stents, which go by the brand name Cypher, have been shown to reduce the chance of arteries becoming blocked again, and therefore the need for another operation. However, so far, there has been limited experience using the stents in patients older than 75 years. Dr. Marcus Wiemer from University Bochum, in Bad Oeynhausen, Germany and colleagues compared outcomes in 954 patients older than 75 years with 5801 younger patients enrolled in the German Cypher Registry. The team found that the mortality rate in the hospital was higher in the older patients (1.0 percent) than in the younger patients (0.3 percent), but there was no significant difference in heart attacks or the need for repeat procedures. After 6 months, the overall mortality was 3-fold higher in the elderly group, but both groups showed significant improvement in symptoms, the report indicates. The investigators say even between octogenarians and patients younger than 80 years old, there were no differences in hospital deaths or major adverse coronary events after 6 months. These results provide "strong evidence that sirolimus-eluting stent implantation in the elderly and in very old patients is feasible and ... should be recommended," the authors conclude. "A common concern of doctors and patients that the elderly will have more problems or side effects during or after interventions" was not seen in this study, Wiemer told Reuters Health. He explained that even these newer stents don't improve the prognosis for people with coronary artery disease, "but we can improve the symptoms significantly." Angina caused by coronary disease is not only painful, "it causes fear of death," he continued. To deny elderly patients treatment that eases these symptoms is "unethical." SOURCE: American Heart Journal, October 2007.