The Question of Angioplasty in the Elderly

We just posted a report on the XIMA Trial which studied stents in octogenarians. The trial compared drug-eluting with bare-metal stents and the results are very interesting: while the trial didn’t find a difference in these two types of stents for the pre-specified composite endpoint of death, heart attack, revascularization, stroke and major bleeding…it did find significantly lower incidence of revascularization and heart attack in those patients who received the drug-eluting Xience stent.

But the real take-away from the XIMA Trial is that stenting and angioplasty in the elderly is safe and effective. Mortality from cardiac causes in this trial was 4% at one year, no matter which stent was used.

The importance of this trial is that elderly patients, those over 80, are routinely excluded from the major randomized clinical trials in interventional cardiology. This is not due to prejudice, but because they tend to have additional illnesses and conditions that would skew results and make the conclusions of the trial not as robust for the majority of patients.

However, as our populations age, and the 6o-year-olds become the 80-year-olds, discerning whether or not these therapies are helpful for elderly patients is critical. Happily, this trial showed a positive result for octogenarians. What wasn’t measured though was the quality of life increase. Imagine you are an 85-year-old suffering from severe angina. Your daily activity is being diminished. Your concern isn’t so much whether angioplasty will improve mortality (you are already well past the “average” life span); your major concern is that you want to live each day that you have to the fullest.

So the results of XIMA are very encouraging.

As reported in our article, principal investigator Dr. Adam de Belder of the U.K. noted that XIMA — pronounced “Zee-mah” — is also a play on words: in the U.K. the walkers used by elderly people are referred to as “Zimmers”, after the company that manufactures them. So the investigatorsĀ  thought XIMA was a fitting acronym.

I have to say that you gotta love the English Shakespearean penchant for puns.

You also gotta love the Brit rock group, The Zimmers — and yes, they named themselves after the walker, too.

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5 Comments

Filed under Antiplatelet Medications, Bare Metal Stents, Clinical Trials / Studies, Drug-Eluting Stents, Heart Attack, Meetings & Conferences, Patients, Stent, Video

5 Responses to The Question of Angioplasty in the Elderly

  1. What a great article, the topic of stents is one particularly close to my heart so it’s always interesting to see news about pertinent developments. The video at the end was a great bonus!

  2. I want to know about success rates of a stent implanted in the right renal artery and the success rate in an 89 year old woman with renal artery stenosis and HTN.?
    Can they be removed if the HTN stays elevated

    • Once expanded inside the artery, stents are not removable (there are cases, but it involves major surgery, excision of the artery segment, etc.). We don’t know of any major studies specifically on success rates of renal angioplasty curing hypertension in elderly patients. In fact, the XIMA Trial, the subject of this article, is one of the few that specifically looked at octogenarians, period! There are new technologies on the horizon that have shown success in treating resistant hypertension. Called “renal denervation”, the procedure is approved in Europe and awaiting the end of a major trial here in the U.S. before FDA approval can be considered. You can read more about this trial here.

  3. karl knudson

    hello ,my mom has a blood pressure problem ,they are giving her a bunch of meds to slow her heart rate, it is makeing her goofy like there is not enough oxy getting to her brain , she ran a fast food resterant for 25 years ,eating greasy food all that time , im knowing that her arteries have got to be blocked , im thinking that she needs a angioplasty done ,it would mechanically fix this problem of high bp, instead of trying to cure with more problematic pills,as bad for liver kidneys etc ,i asked the doc ,he said she is to old for a angioplasty , im really upset they wount try to do this, any input for me?she is 92

    • Karl, high blood pressure may have nothing to do with coronary artery disease (blocked arteries), so without specific evidence of coronary artery narrowing, it’s really not possible to say that angioplasty would be an appropriate therapy.

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