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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Routine percutaneous coronary intervention in elderly patients with cardiogenic shock complicating acute myocardial
Angela Migliorini1, Guia Moschi, Renato Valenti
1Division of Cardiology, Careggi Hospital, Florence, Italy.
Insights
Elderly patients with acute myocardial infarction (AMI) and cardiogenic shock (CS) benefit from early percutaneous coronary intervention (PCI). Despite higher mortality, successful PCI improves outcomes in older individuals.
Area of Science:
- Cardiology
- Geriatrics
- Interventional Cardiology
Background:
- Age is a significant risk factor for mortality in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).
- Limited data exist on the effectiveness of early percutaneous coronary intervention (PCI) in elderly patients experiencing CS following AMI.
Purpose of the Study:
- To analyze age-related outcomes in patients with AMI and CS undergoing primary PCI.
- To evaluate the feasibility and impact of a routine early PCI strategy in elderly individuals with CS complicating AMI.
Main Methods:
- Analysis of 280 consecutive patients with AMI complicated by CS who underwent primary PCI between 1995 and 2004.
- Comparison of outcomes between elderly (≥75 years) and younger patient groups.
Main Results:
- Elderly patients (≥75 years) constituted 37% of the study cohort, with a mean age of 81 years.
- PCI success rates were high in both groups (92% elderly vs. 97% younger, P=.062).
- Six-month mortality was significantly higher in the elderly group (56% vs. 26%, P<.001), with age and PCI failure independently predicting 1-year mortality.
Conclusions:
- Routine emergency PCI is a feasible strategy for elderly patients with CS complicating AMI.
- Advanced age remains a strong predictor of mortality in this population.
- Successful PCI in elderly patients with CS yields better outcomes than previously reported.
Background:
Age is a strong predictor of cardiogenic shock (CS) and death in patients with acute myocardial infarction (AMI). Few data on the impact of a routine early percutaneous revascularization strategy in elderly patients with CS complicating AMI exist.
Methods:
We performed an analysis of age-related differences in outcome in 280 consecutive patients with AMI complicated by CS who underwent primary percutaneous coronary intervention (PCI) between January 1995 and September 2004 and who were included in a single-center prospective registry of primary PCI for AMI.
Results:
Of the 280 patients with CS, 104 (37%) were > or = 75 years. The mean age of the elderly group was 81 +/- 5 years, and half of the patients were > or = 80 years. Most patients in both groups underwent PCI within 6 hours of their symptom onset. The PCI success rates were 92% in the elderly group and 97% in the younger patient group (P = .062). The 6-month mortality rates were 56% in the elderly group and 26% in the younger patient group (P < .001). At multivariate analysis, the variables independently related to the risk of 1-year mortality in the elderly group were age (hazard ratio 1.07, 95% CI 1.02-1.12, P = .005) and PCI failure (hazard ratio 4.01, 95% CI 1.53-10.51, P = .005).
Conclusion:
A strategy of routine emergency PCI in elderly patients with CS complicating AMI is highly feasible. Among elderly patients, age remains to be a strong predictor of mortality. However, outcome after successful PCI is better than previously reported.
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