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Published on: June 12, 2021
Age-related outcomes in patients with cardiogenic shock stratified by etiology
Alexander Schmitt1,2, Kathrin Weidner1,2, Jonas Rusnak1,2
1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Insights
Increasing age did not impact mortality in all cardiogenic shock patients. However, older patients with acute myocardial infarction-related cardiogenic shock faced higher 30-day mortality risks.
Area of Science:
- Cardiology
- Geriatric Medicine
- Critical Care Medicine
Background:
- Cardiovascular disease patient demographics are shifting towards older individuals with complex comorbidities.
- Limited data exists on the prognostic impact of advanced age in cardiogenic shock (CS).
- This study addresses the prognostic significance of age in CS patients.
Purpose of the Study:
- To investigate the prognostic impact of age on 30-day all-cause mortality in patients with cardiogenic shock.
- To analyze age as a predictor of mortality across different etiologies of CS.
Main Methods:
- Consecutive CS patients (2019-2021) were analyzed for 30-day all-cause mortality.
- Age groups (60-80 years and >80 years) were compared.
- Statistical analyses included Spearman's correlations, Kaplan-Meier, and multivariable Cox regression, with risk assessment stratified by CS etiology, particularly acute myocardial infarction (AMI).
Main Results:
- Among 223 CS patients (median age 77 years), no significant difference in 30-day mortality was found between age groups (54.6% vs. 63.4%, P=0.169).
- In the subgroup of acute myocardial infarction-related CS, patients over 80 years showed a significantly increased 30-day mortality risk (78.1% vs. 60.0%, P=0.032).
- This increased risk in older AMI-CS patients remained significant after multivariable adjustment (HR=2.072, P=0.012).
Conclusions:
- Age is not a significant predictor of 30-day mortality in mixed-etiology cardiogenic shock.
- Advanced age (>80 years) is a significant independent predictor of increased 30-day mortality risk specifically in patients with acute myocardial infarction-related cardiogenic shock.
Background:
As a result of improved and novel treatment strategies, the spectrum of patients with cardiovascular disease is consistently changing. Overall, those patients are typically older and characterized by increased burden with comorbidities. Limited data on the prognostic impact of age in cardiogenic shock (CS) is available. Therefore, this study investigates the prognostic impact of age in patients with CS.
Methods:
From 2019 to 2021, consecutive patients with CS of any cause were included. The prognostic value of age (i.e., 60-80 years and > 80 years) was investigated for 30-day all-cause mortality. Spearman's correlations, Kaplan-Meier analyses, as well as multivariable Cox proportional regression analyses were performed for statistics. Subsequent risk assessment was performed based on the presence or absence of CS related to acute myocardial infarction (AMI).
Results:
223 CS patients were included with a median age of 77 years (interquartile range: 69-82 years). No significant difference in 30-day all-cause mortality was observed for both age-groups (54.6% vs. 63.4%, log-rank P = 0.169; HR = 1.273, 95% CI: 0.886-1.831, P = 0.192). In contrast, when analyzing subgroups stratified by CS-etiology, AMI-related CS patients of the group > 80 years showed an increased risk of 30-day all-cause mortality (78.1% vs. 60.0%, log-rank P = 0.032; HR = 1.635, 95% CI: 1.000-2.673, P = 0.050), which was still evident after multivariable adjustment (HR = 2.072, 95% CI: 1.174-3.656, P = 0.012).
Conclusions:
Age was not associated with 30-day all-cause mortality in patients with CS of mixed etiology. However, increasing age was shown to be a significant predictor of increased mortality-risk in the subgroup of patients presenting with AMI-CS.
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