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Cardiogenic shock complicating acute myocardial infarction in the elderly: Predictors of long‐term survival
Author(s) -
Tomassini Francesco,
Gagnor Andrea,
Migliardi Alessandro,
Tizzani Emanuele,
Infantino Vincenzo,
Giolitto Sara,
Rosa Conte Maria,
Antonio Lanza Gaetano,
Gnavi Roberto,
Varbella Ferdinando
Publication year - 2011
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.22911
Subject(s) - medicine , cardiogenic shock , conventional pci , hazard ratio , myocardial infarction , percutaneous coronary intervention , cardiology , revascularization , proportional hazards model , surgery , confidence interval
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. © 2010 Wiley‐Liss, Inc.