Comparison of One-Year Outcomes in Patients >75 Versus ≤75 Years with Coronary Artery Disease Treated with COMBO Stents (From The MASCOT Registry)

ABSTRACT Older patients undergoing coronary interventions are at greater risk of ischemic events and less likely to tolerate prolonged dual antiplatelet therapy (DAPT) due to bleeding risk. The COMBO biodegradable-polymer sirolimus-eluting stent promotes rapid endothelialization via endothelial progenitor cell capture technology which may be advantageous in elderly patients. We compared 1-year clinical outcomes and DAPT cessation events in patients >75 versus ≤75 years from the MASCOT registry. MASCOT was a prospective, multicenter cohort study of all-comers undergoing attempted COMBO stenting. The primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, myocardial infarction (TV-MI) not clearly attributed to a non-target vessel or clinically-driven target lesion revascularization (TLR). Bleeding was adjudicated using the Bleeding Academic Research Consortium (BARC) criteria. Adjusted outcomes were analyzed using Cox regression methods. The study included 18% (n=479) patients >75 years and 72% (n=2135) patients ≤75 years. One-year TLF occurred in 4.6% patients >75 years vs. 3.1% patients ≤75years of age, p=0.10; adj HR 1.36, 95% CI 0.77-2.38, p=0.29. There were no significant differences in cardiac death (1.7% vs. 1.3%, p=0.55), TV-MI (2.1% vs. 1.2%, p=0.14), TLR (1.7% vs 1.4%, p =0.60) and definite stent thrombosis (0.8% vs. 0.4%, p =0.19). Major BARC 3,5 bleeding (3.1% vs. 1.5%, p=0.01) and DAPT cessation rates (32.4% vs. 23.0%, p 75years treated with COMBO stents had similar TLF but significantly greater incidence of bleeding than younger patients and DAPT cessation in one-third of patients over 1-year.