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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Outcomes of elderly patients with cardiogenic shock treated with early percutaneous revascularization
Abhiram Prasad1, Ryan J Lennon, Charanjit S Rihal
1Division of Cardiovascular Diseases and Department of Internal Medicine, Rochester, Minn, USA.
Insights
Elderly patients (>=75) with acute myocardial infarction (MI) and cardiogenic shock (CS) have high mortality. Early percutaneous coronary intervention (PCI) may improve outcomes in selected older patients with MI and CS.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Subgroup analysis of the SHOCK trial suggested harm from early revascularization in patients >=75 with MI and CS.
- The 30-day mortality in this subgroup was 75%, with unclear applicability to the general population.
Purpose of the Study:
- To evaluate the outcomes of elderly patients (>=75) with cardiogenic shock (CS) due to acute myocardial infarction (MI) who underwent urgent percutaneous coronary intervention (PCI).
Main Methods:
- Retrospective evaluation of 61 patients aged >=75 with CS caused by MI who underwent urgent PCI at Mayo Clinic (1991-2000).
- Data collected on patient demographics, medical history, time to PCI, angiographic success, and in-hospital and 30-day outcomes.
Main Results:
- Mean age was 79.5 years; 41% had prior MI, 28% had diabetes.
- Angiographic success was achieved in 91% of lesions.
- In-hospital mortality was 44%, 30-day mortality was 47%, and 1-year survival was 75% among survivors.
Conclusions:
- Patients >=75 with MI complicated by CS have high early mortality.
- Urgent PCI in selected elderly patients with MI and CS may lead to better outcomes than previously suggested.
- Hospital discharge survival was 56%, with 75% of survivors alive at 1 year.
Background:
Subgroup analysis from the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial indicated that patients with acute myocardial infarction (MI) complicated by cardiogenic shock (CS) who were > or =75 years old did not benefit from early revascularization and may have been harmed; their mortality rate at 30 days was 75%. The applicability of this subset analysis from a select patient population enrolled in a randomized trial to the general population is unclear.
Methods:
At the Mayo Clinic between 1991 and 2000, we evaluated the outcome of all patients > or =75 years old with CS caused by MI who underwent urgent percutaneous coronary intervention (PCI).
Results:
The study included 61 patients with a mean age of 79.5 +/- 3 years; 21% of these patients had a history of prior coronary artery bypass grafting (CABG), 41% had had a prior MI, 28% had diabetes mellitus, and 18% had a history of a cerebrovascular accident (CVA). PCI was performed 8.0 +/- 7.2 hours after onset of MI. Angiographic success (<50% residual stenosis) was achieved in 91% of the lesions that were dilated. In hospital outcomes included death (44%), CABG (1.6%), and CVA (4.9%). The 30-day mortality rate was 47%. The estimated survival rate 1 year after discharge (Kaplan Meier method) was 75%.
Conclusions:
These data confirm a high early mortality rate among patients > or =75 years old with MI complicated by CS, but suggest that among patients referred for angiography, outcomes may be better than previously believed when early revascularization is performed. In this population, 56% of patients survived to be discharged from the hospital, and of the hospital survivors, 75% were alive at 1 year.
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