Survival benefit from early revascularization in elderly patients with cardiogenic shock after acute myocardial infarction: a cohort study
Amit P Amin1, Sandeep Nathan, Prathima Prodduturi
1John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA. amit_p_amin@yahoo.com
Insights
Early revascularization improves survival for elderly patients (≥75 years) experiencing cardiogenic shock (CS) after acute myocardial infarction (AMI). This survival benefit is significant and sustained throughout follow-up.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Cardiogenic shock (CS) following acute myocardial infarction (AMI) presents significant treatment challenges, particularly in elderly populations.
- Optimal management strategies for elderly patients with CS post-AMI are not well-defined.
Purpose of the Study:
- To evaluate the survival advantage of early revascularization in patients aged 75 years and older who develop CS after AMI.
- To compare the survival benefit in elderly patients with that observed in younger patients.
Main Methods:
- Survival analysis of 310 patients with CS post-AMI, including 80 patients aged ≥75 years.
- Utilized Kaplan-Meier plots, Cox proportional hazards modeling, and logistic regression to analyze survival data.
- Data collected over a 6-year period from two major medical centers.
Main Results:
- Early revascularization was associated with a significant survival benefit in both younger (<75 years) and older (≥75 years) patient groups.
- For patients ≥75 years, the relative hazard of mortality was 0.56 (95% CI 0.32-0.99; p=0.049), indicating improved survival.
- This survival benefit in the elderly was observed early and persisted throughout the follow-up period, even after adjusting for confounders.
Conclusions:
- Early revascularization offers a significant survival benefit for elderly patients (≥75 years) with CS complicating AMI.
- While beneficial, the survival advantage in the oldest patients was less pronounced compared to younger individuals.
- These findings support considering early revascularization as a therapeutic option for elderly patients with CS post-AMI.
Objectives:
To assess if early revascularization offers any survival benefit in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) who are > or = 75 years of age.
Background:
CS after AMI continues to pose formidable therapeutic challenges in elderly patients.
Methods:
We conducted survival analyses of 310 consecutive subjects (including 80 patients > or = 75 years of age) who developed cardiogenic shock after AMI at two study centers - Rush University Medical Center and the John H. Stroger Jr. Hospital of Cook County (both in Chicago, Illinois). The data were collected over a 6-year period. Where appropriate, we used Kaplan-Meier survival plots, multivariate Cox proportional hazards modeling, stepwise multivariate Poisson regression analyses and unconditional logistic regression analysis.
Results:
Early revascularization was associated with a statistically significant survival benefit both in patients < 75 years of age (relative hazard 0.40, 95% confidence interval [CI] 0.28-0.59; p < 0.001), as well as in patients > or = 75 years of age (relative hazard 0.56, 95% CI 0.32-0.99; p = 0.049). This benefit remained significant even after adjusting for the simultaneous effects of several putative confounders. In patients > or = 75 years of age, this survival benefit was evident very early and was sustained all through the period of follow up of the cohort.
Conclusions:
These retrospective data suggest a significant survival benefit of early revascularization in elderly patients > or = 75 years of age developing CS after AMI, albeit less as compared to those aged < 75 years.
