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Published on: June 12, 2021
Outcome in Elderly Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction
Hanna Louise Ratcovich1, Jakob Josiassen1, Ole Kristian Lerche Helgestad2,3
1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Insights
Elderly patients (≥75 years) with cardiogenic shock after myocardial infarction face high mortality. Lower lactate and heart rate at admission predict better outcomes for these high-risk individuals.
Area of Science:
- Cardiology
- Geriatric Medicine
- Critical Care Medicine
Background:
- Cardiogenic shock following acute myocardial infarction (AMICS) has a high in-hospital mortality rate, around 50%.
- Outcomes in AMICS vary significantly among patient subsets, with the elderly population often exhibiting a poorer prognosis.
- Tertiary care centers manage complex AMICS cases, but outcomes in elderly patients require specific investigation.
Purpose of the Study:
- To investigate the outcomes of elderly patients (≥75 years) with AMICS referred for evaluation and treatment at a tertiary university hospital.
- To identify factors associated with 30-day mortality in this specific patient group.
- To understand treatment patterns and their impact on survival among elderly AMICS patients.
Main Methods:
- Analysis of the RETROSHOCK registry, including individually identified and validated AMICS patients admitted to tertiary care.
- Comparison of treatment patterns and baseline characteristics between elderly (≥75 years) and younger AMICS patients.
- Multivariable analysis to identify independent predictors of 30-day mortality in elderly AMICS patients.
Main Results:
- Elderly patients (≥75 years) constituted 28.9% of admitted AMICS patients.
- Older patients were less likely to receive direct tertiary admission, mechanical support, or revascularization.
- Higher age, heart rate, and lactate levels at admission were associated with increased 30-day mortality in elderly patients, while higher ejection fraction and lower lactate predicted survival.
Conclusions:
- The 30-day mortality rate for elderly patients (≥75 years) with AMICS referred for tertiary care was high at 73.4%.
- Survivors among the elderly AMICS population were characterized by lower arterial lactate and heart rate upon admission.
- These findings highlight the critical condition of elderly AMICS patients and the need for optimized management strategies.
Introduction:
Despite advances in treatment of patients with cardiogenic shock following acute myocardial infarction (AMICS) in-hospital mortality remains around 50%. Outcome varies among patient subsets and the elderly often have a poor a priori prognosis. We sought to investigate outcome among elderly AMICS patients referred to evaluation and treatment at a tertiary university hospital.
Methods:
Current analysis was based on the RETROSHOCK registry comprising consecutive AMICS patients admitted to tertiary care. Patients in the registry were individually identified and validated.
Results:
Of 1,716 admitted patients, 496 (28.9%) patients were ≥75 years old. Older patients were less likely to be admitted directly to a tertiary centre (59.4% vs. 69.9%, P = 0.003), receive mechanical support devices (i.e., Impella® (8.9% vs. 15.0%, P = 0.003), and undergo revascularization attempt (76.8% vs. 90.2%, P < 0.001). Thirty-day survivors ≥75 years were characterized by having higher left ventricular ejection fraction (30.2% ± 12.5% vs. 26.5% ± 11.8%, P = 0.004) and lower arterial lactate (3.2[2.2-5.2] mmol/L vs. 5.5[3.3-8.2] mmol/L, P < 0.001) at admission. In a multivariable analysis of patients ≥75 years, higher age (HR 1.09, 95% CI 1.05-1.14, P < 0.001), higher heart rate (HR 1.01, 95% CI 1.001-1.014, P = 0.03), and higher lactate (HR 1.11, 95% CI 1.07-1.16, P < 0.001) at admission were associated with an increased risk of 30-day mortality.
Conclusion:
Among patients ≥75 years with AMICS referred for tertiary specialized treatment, 30-day mortality was 73.4%. Survivors were characterized by lower arterial lactate and heart rate at admission.
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