Friday, November 02, 2012


Sometimes a question arises. If my mother of 86years old has unstable angina, would I do PCI? If I do, which stent should I implant?
This happened last week, when a colleague called me one evening and said that his mother ( 80+ yrs old ), who is a known hypertensive,  now has angina on minimal effort, and asked what I would do? Conservative me, said that I would give a trial of intensive medical therapy and rest. medical therapy including a CCB, beta blocker, nitrates and plavix, with GTN PRN. If it does not settle down, we should contemplate coronary angiogram and PCI. Fortunately, it settle down.
As we all know, doing PCI in an octogenarian carries a significantly higher procedural risk, and implanting a DES means a longer period of dual anti-platelet therapy, with an increase risk of bleeding. Of course, the bare metal stents have a higher risk of restenosis.
There was a paper presented at the just concluded TCT annual scientific session at Florida on the XIMA study. The XIMA study is a prospective randomised trial of the Everolimus eluting stent Vs the bare metal stent in the Octogenarian. 800 patients with angina, from UK and Spain, were randomised to receive either EVS or BMS. After 1 year of followup, there was no significant increase risk of bleed but a significant risk of re-stenosis requiring re-intervention.. There was a slightly higher absolute number of bleeds with DAPT but the difference was not significant. Consideriing that the mean age in this study is 83yrs old, and that 50% of the study population had acute coronary syndrome, this study results is significant to answer the question of which stent we should implant in octogenarians with acute coronary syndrome.

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