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 investigators 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.