C  2006, the Authors Journal compilation C  2006, Blackwell Publishing, Inc. Age-Based Differences of Percutaneous Coronary Intervention in the Drug-Eluting Stent Era KEVIN C. FLOYD, M.D., JOHN E. JAYNE, M.D., AARON V. KAPLAN, M.D., BRUCE J. FRIEDMAN, M.D., NATHANIEL W. NILES, M.D., BRUCE D. HETTLEMAN, M.D., JOHN F. ROBB, M.D., and CRAIG A. THOMPSON, M.D., M.M.SC. From the Department of Medicine, Cardiology Section, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, Lebanon, New Hampshire Introduction: Limited data are available on contemporary percutaneous coronary intervention (PCI) practice patterns and outcomes in elderly patients. The objective of this study was to evaluate “real-world” PCI in elderly and nonelderly patients during the first year of availability of drug-eluting stents (DES) in the United States market (May 1, 2003–April 30, 2004). Methods: One thousand one hundred sixty-six consecutive patients (272 elderly [age ≥75 years] and 894 nonelderly [age <75 years]) having PCI for de novo coronary artery disease (CAD) at Dartmouth-Hitchcock Medical Center were included in this study. Primary outcome measures of this study were in-hospital major adverse cardiac events (MACE—death, new MI, urgent revascularization). Secondary end points included acute renal failure, respiratory failure, and vascular complications. Results: Elderly patients had higher MACE (8.5% vs 1.5%, P ≤ 0.001), unadjusted in-hospital mortality (7.4% vs 0.8%, P ≤ 0.001), in-hospital cardiac arrest (1.5% vs 0.3%, P = 0.03), requirements for assisted blood pressure support (13.2% vs 7.0%, P = 0.0001), respiratory failure (2.2% vs 0.9%, P = 0.08), acute renal failure (2.9% vs 0.8%, P = 0.005), and vascular complications (10.3% vs 5.5%, P = 0.005) than their nonelderly counterparts. Higher MACE rates persisted in the elderly despite correction for baseline differences using multivariate regression modeling. Conclusions: Advanced age remains a predictor of adverse outcomes attending PCI even in the contemporary era in which DES are available. This study highlights the need for further progress and investigation to optimize outcomes of PCI in the elderly. (J Interven Cardiol 2006;19:381–387) Introduction Drug-eluting stents (DES) improve the efficacy of percutaneous coronary artery revascularization by de- creasing neointimal development and resultant in-stent restenosis. 1–15 This improvement in percutaneous coro- nary intervention (PCI) durability has led to widespread adoption of DES throughout the interventional cardi- ology community. However, randomized clinical trials that have demonstrated efficacy have been performed in limited patient populations and lesion subsets. Lim- ited data are available to define practice patterns and Address for reprint: Craig A. Thompson, M.D., M.M.Sc., Dart- mouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756. Fax: 603-650-6164; e-mail: Craig.A. Thompson@Dartmouth.edu outcomes in elderly patients in the contemporary set- ting of PCI with DES utilization. The purpose of this study is to provide insights into PCI performed in the elderly by evaluating age-based practice patterns and outcomes from the “real-world” experience of a large volume, tertiary referral center during the first year of the DES availability in the United States. Material and Methods One thousand one hundred sixty-six consecutive pa- tients between May 1, 2003, and April 30, 2004, having PCI for de novo coronary artery disease (CAD) at Dart- mouth Hitchcock Medical Center were included in this study, irrespective of indication for cardiac catheteriza- tion and PCI. Patients with prior coronary artery bypass surgery (CABG) were included if only native coronary Vol. 19, No. 5, 2006 Journal of Interventional Cardiology 381