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[Influence of age in short and long term prognostic of ischemic cardiogenic shock]
Víctor M Hidalgo-Olivares1, Juan Gabriel Córdoba-Soriano1, Isabel López-Neira1
1Servicio de Cardiología, Hospital General Universitario de Albacete, Albacete, España.
Insights
Elderly patients experiencing myocardial infarction with cardiogenic shock face high in-hospital mortality and worsening long-term prognosis. Early revascularization did not significantly alter outcomes in this high-risk group.
Area of Science:
- Cardiology
- Geriatric Medicine
- Critical Care Medicine
Context:
- Myocardial infarction complicated by cardiogenic shock presents a significant clinical challenge.
- Elderly patients represent a vulnerable population with potentially poorer outcomes.
Purpose:
- To compare the in-hospital and 4-year follow-up prognosis of elderly patients (Group A, >75 years) versus younger patients (Group B, <75 years) with myocardial infarction and cardiogenic shock.
- To evaluate the impact of early coronary revascularization on mortality in these patient groups.
Summary:
- A prospective observational study included 97 patients with myocardial infarction and cardiogenic shock who underwent early revascularization.
- Group A (elderly) had higher in-hospital mortality (54.5% vs. 30.2%, P=.022) and 4-year mortality (73% vs. 38%, P=.007) compared to Group B.
- Elderly patients in Group B were more likely to be male, diabetic, and smokers.
Impact:
- Myocardial infarction with cardiogenic shock in the elderly is associated with very high mortality during hospitalization and sustained high mortality during long-term follow-up.
- These findings underscore the critical need for improved therapeutic strategies and risk stratification for elderly patients with cardiogenic shock post-myocardial infarction.
Objective:
To compare the prognosis during hospitalization and maximum follow-up of 4 years in patients with myocardial infarction complicated with cardiogenic shock.
Method:
Prospective observational study practiced in a coronary Care Unit managed by cardiologists. We included patients with myocardial infarction complicated with cardiogenic shock who received early coronary revascularization. Patients were divided into two groups: older than 75 years (group A) and lower (group B), and we compared the evolution during hospitalization and maximum follow-up of 4 years. Primary end point was mortality rate in the maximum follow-up of 4years. Secondary end point was mortality rate during hospitalization.
Results:
Ninety-seven patients were included, 45% Group A. Patients of Group B were mostly men (81% vs. 57%; P=.014), diabetics (48% vs. 21%; P=0.006), and smokers (39.6% vs. 5%). Mortality rate during hospitalization was higher in Group A (54.5%) vs. 30.2% in Group B (P=.022). Mortality rate during follow-up (primary variable) was 73% in Group A vs. 38% in Group B (P=.007).
Conclusions:
Myocardial infarction complicated with cardiogenic shock in elderly patients is an entity with high mortality during hospitalization and continues to worsen during long term follow-up.
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