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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Procedural Success Rates and Mortality in Elderly Patients With Percutaneous Coronary Intervention for

Uwe Zeymer1, Mathias Hochadel2, Ann-Kathrin Karcher3

  • 1Klinikum Ludwigshafen, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.

JACC. Cardiovascular Interventions
|September 21, 2019
PubMed

Insights

Age impacts outcomes for patients with cardiogenic shock (CS) undergoing percutaneous coronary intervention (PCI). While PCI is safe across age groups, mortality significantly increases with advancing age in acute myocardial infarction (AMI) patients with CS.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Cardiology

Background:

  • Percutaneous coronary intervention (PCI) improves outcomes for acute myocardial infarction (AMI) patients with cardiogenic shock (CS).
  • The impact of patient age on PCI outcomes in CS remains a critical area of investigation.

Purpose of the Study:

  • To evaluate the influence of age on procedural and clinical outcomes in patients with AMI and CS undergoing PCI.
  • To compare outcomes across different age strata.

Main Methods:

  • Analysis of prospectively collected data from the ALKK PCI registry (2010-2015).
  • Inclusion of 2,323 consecutive patients with AMI and CS treated with PCI.
  • Stratification of patients into four age groups: <65, 65-74, 75-84, and >85 years.

Main Results:

  • Procedural success (TIMI flow grade 3) decreased with age (84% to 78%).
  • In-hospital mortality significantly increased with age, from 32% in younger patients to 56% in the oldest group.
  • Bleeding rates were consistently low (2.0%-2.3%) and not significantly different across age groups.
  • Higher age, suboptimal post-PCI flow, 3-vessel disease, and left main PCI were independent predictors of mortality.

Conclusions:

  • PCI demonstrates high procedural success and low bleeding rates in AMI patients with CS, including the elderly.
  • Increasing age is independently associated with higher mortality in this patient population.
  • Despite increased mortality risk, PCI in selected elderly CS patients is justified due to very high mortality rates without intervention.
Abstract

Keywords:
agecardiogenic shockpercutaneous coronary interventionrevascularization

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