Contemporary Management of Cardiogenic Shock

Cardiogenic shock complicating acute myocardial infarction in the elderly: predictors of long-term survival

BACKGROUND

Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI), associated with a high mortality. A significant improvement in survival has been reported with immediate coronary revascularization. However, there is no clear evidence of such an improvement amongst older patients. The aim of our work was to evaluate in-hospital and long-term outcomes in the group of elderly AMI patients with CS (≥75 years old).

METHODS

We collected data of 157 consecutive AMI patients with CS who underwent percutaneous coronary intervention (PCI) and compared clinical and procedural characteristics and in-hospital and long-term outcomes between patients <75 years and patients ≥75 years old.

RESULTS

There were 58 patients (36.9%) with age ≥75 years and 99 patients (63.1%) with age <75 years. Patients were followed up for an average period of 34 months (range 5-69). In-hospital and long-term mortality was significantly higher in the older group (55 vs. 25%, P < 0.0001; and 62.1 vs. 37.3%, P = 0.005, respectively). Multivariate predictors of in-hospital mortality were age ≥75 years (hazard ratio 1.81, 95% CI 1.006-3.27, P = 0.04) and PCI failure (hazard ratio 2.67, 95% CI 1.34-5.307, P = 0.005), whereas, the only multivariate predictor of long-term mortality was PCI failure (hazard ratio 2.88, 95% CI 1.52-5.46, P = 0.001). Age ≥75 years showed only a trend toward statistical significance (hazard ratio 1.62, 95% CI 0.96-2.76, P = 0.07).

CONCLUSIONS

In elderly AMI patients with CS, PCI can be performed with an acceptable risk that seems lower than that reported in most previous studies.