XIMA Study Compares Abbott's DES and BMS to Treat Octogenarians With Angina

January 29, 2014—Adam de Belder, MD, et al published findings from the XIMA study online ahead of print in the Journal of the American College of Cardiology (JACC). XIMA is a prospective randomized trial of the Xience everolimus-eluting stent (Abbott Vascular, Santa Clara, CA) versus the Vision bare-metal stent (Abbott Vascular) for the management of angina in the elderly. The objective of the XIMA study is to determine whether drug-eluting stents (DES) are superior to bare-metal stents (BMS) in treating octogenarian patients with angina.

The XIMA investigators concluded that both BMS and DES offer good clinical outcomes in this age group but that DES stents were associated with a lower incidence of myocardial infarction (MI) and target vessel revascularization (TVR), without an increased incidence of major hemorrhage.

The background of the investigation is that patients aged 80 years or older frequently have complex coronary disease warranting DES but have a higher bleeding risk from prolonged dual-antiplatelet therapy.

As summarized in JACC, this multicenter randomized trial was conducted at 20 centers in the United Kingdom and Spain. Patients aged 80 years or older underwent stenting for angina. The primary endpoint was a 1-year composite of death, MI, cerebrovascular accident, TVR, or major hemorrhage.

In the study, 800 patients aged 83.5 ± 3.2 years were randomized to BMS (n = 401) or DES (n = 399) for treatment of stable angina (32%) or acute coronary syndrome (68%).

The investigators noted that procedural success did not differ between groups (BMS = 97.7% vs DES = 95.4%; P = .07). Thirty-eight percent of patients had two or more vessels treated by percutaneous transluminal intervention, and 66% underwent complete revascularization. BMS patients had shorter stent implantation times (24 ± 13.4 mm vs 26.6 ± 14.3 mm; P = .01).

At 1 year, dual-antiplatelet therapy rates were 32.2% for BMS and 94% for DES. The primary endpoint occurred in 18.7% of BMS and in 14.3% of DES patients (P = .09). There was no difference in death (7.2% vs 8.5%; P = .5), major hemorrhage (1.7% vs 2.3%; P = .61), or cerebrovascular accident (1.2% vs 1.5%; P = .77). The incidence of MI (8.7% vs 4.3%; P = .01) and TVR (7% vs 2%; P = .001) occurred more often in the BMS group, reported the investigators in JACC.