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[Comment] A SENIOR moment? Bare-metal stents in elderly patients

The WHO International Day of Older Persons1 was on Oct 1, 2017, and saw the release of guidelines on integrated care and equality of care for older people. Now, 40 years since the first percutaneous coronary intervention (PCI),2 we still do not know the optimal revascularisation strategy in elderly patients. Interventionalists face two important questions when considering PCI in elderly patients. First, should drug-eluting stents (DES) be mandated in elderly patients since they tend to have greater numbers of complex coronary lesions with calcification, tortuosity, and bifurcations than do younger patients3 and DES have been shown to be better than bare-metal stents (BMS), particularly in complex lesions?4 Second, since DES require a longer duration of dual antiplatelet therapy (6–12 months) than do BMS (1 month), does the benefit of DES outweigh the risk associated with extended DAPT (dual antiplatelet therapy; risk of life-threatening bleeding) or should patients have shortened DAPT with its attendant risk of myocardial infarction and stent thrombosis?5

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