Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction...

Area of Science:

• Cardiology
• Geriatric Medicine
• Clinical Trials

Background:

• The SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK (SHOCK) Trial indicated no survival benefit for early revascularization in older patients (>75 years) with acute myocardial infarction and cardiogenic shock.
• Age-related differences in treatment and outcomes for cardiogenic shock remain incompletely understood.

Purpose of the Study:

• To investigate the impact of age on treatment strategies and mortality in patients experiencing cardiogenic shock within the SHOCK Trial Registry.
• To compare outcomes of early versus delayed/no revascularization across different age groups.

Main Methods:

• Analysis of the SHOCK Trial Registry, comparing patients aged <75 years (n=588) and >=75 years (n=277).
• Evaluation of 30-day mortality based on timing of revascularization (early <18 hours vs. late/none).
• Covariate-adjusted relative risks and confidence intervals calculated after excluding early deaths.

Main Results:

• Older patients presented with more comorbidities, prior myocardial infarction, heart failure, renal insufficiency, and complex coronary anatomy.
• In-hospital mortality was significantly lower with early revascularization in both age groups (45% vs. 61% for <75 years; 48% vs. 81% for >=75 years).
• Adjusted analysis showed a relative risk of 0.76 (p=0.045) for <75 years and 0.46 (p=0.002) for >=75 years, favoring early revascularization.

Conclusions:

• Elderly patients with myocardial infarction and cardiogenic shock are less frequently treated with invasive procedures compared to younger counterparts.
• Covariate-adjusted analysis demonstrates that elderly patients selected for early revascularization experience reduced mortality rates.