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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Outcomes of percutaneous coronary intervention among elderly patients in cardiogenic shock: a multicenter,
Harold L Dauerman1, Thomas J Ryan, Winthrop D Piper
1University of Vermont College of Medicine, Burlington, Vermont, USA. harold.dauerman@vtmednet.org
Insights
Emergent percutaneous coronary intervention (PCI) for elderly patients in cardiogenic shock has a real-world mortality rate of 46%, which is lower than previously reported. This suggests PCI is a viable option for carefully selected elderly patients experiencing cardiogenic shock.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Current guidelines recommend early revascularization for acute myocardial infarction with cardiogenic shock, but restrict this to patients under 75.
- This age restriction stems from prior evidence suggesting very high mortality rates in elderly patients undergoing early revascularization.
- The actual in-hospital mortality for elderly patients undergoing emergent percutaneous coronary intervention (PCI) for cardiogenic shock remains largely undetermined.
Purpose of the Study:
- To determine the characteristics and in-hospital mortality rate of elderly patients experiencing cardiogenic shock who undergo emergent PCI.
- To compare these outcomes between elderly (≥75 years) and non-elderly (<75 years) patients.
Main Methods:
- A decade of data (1990-2000) from a prospective registry of consecutive PCIs in Northern New England was analyzed.
- Patient characteristics and in-hospital mortality were compared between elderly and non-elderly groups.
- Multivariate logistic regression identified predictors of hospital survival.
Main Results:
- Out of 52,418 patients, 310 (0.59%) underwent PCI for cardiogenic shock; 24% were elderly.
- Procedural characteristics were similar between age groups.
- Independent mortality predictors included older age and lack of collaterals. During the stent era (1997-2000), lack of stent placement and diabetes mellitus were significant predictors.
- The in-hospital mortality rate for elderly shock patients undergoing PCI was 46%, lower than previously reported in randomized trials.
Conclusions:
- Emergent percutaneous coronary intervention (PCI) for carefully selected elderly patients with cardiogenic shock is feasible.
- Real-world mortality rates for this patient group undergoing PCI are significantly lower than those observed in randomized clinical trials.
Objectives:
The objective of this study was to determine the characteristics and hospital mortality rate for elderly patients in cardiogenic shock undergoing emergent percutaneous coronary intervention (PCI).
Background:
Early revascularization for patients with acute myocardial infarction complicated by cardiogenic shock is recommended for patients < 75 years of age. This age-restricted recommendation is based upon evidence that elderly shock patients undergoing early revascularization have extremely high hospital mortality rates. The real world mortality rate for elderly shock patients undergoing emergent PCI has not been determined.
Methods:
We examined a decade-long experience in our prospective registry of consecutive PCIs in Northern New England to assess the generalizability of these findings. Characteristics and hospital mortality were compared for elderly ( 75 years old) versus non-elderly (< 75 years old) patients. Predictors of hospital survival were identified using multivariate logistic regression.
Results:
From 1990 to 2000, a total of 310 out of 52,418 patients (0.59%) had PCI for cardiogenic shock, twenty-four percent of whom were elderly. Procedural characteristics were similar between the 2 groups. Independent predictors of mortality for both groups were older age and the absence of collaterals; during the stent era (1997 2000), significant predictors were lack of stent placement and diabetes mellitus. The mortality rate for elderly shock patients undergoing PCI was 46%, which is significantly less than previously reported in randomized clinical trials.
Conclusion:
Real world selection of elderly shock patients for PCI is possible with mortality rates far less than seen in randomized trials.
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