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Updated: Jul 16, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Percutaneous coronary intervention for ST-elevation myocardial infarction complicated by cardiogenic shock in a
Kensaku Nishihira1, Satoshi Honda2, Misa Takegami3,4
1Department of Cardiology, Miyazaki Medical Association Hospital, 1173 Arita, Miyazaki 880-2102, Japan.
Insights
Percutaneous coronary intervention (PCI) significantly reduces in-hospital mortality for ST-segment elevation myocardial infarction with cardiogenic shock (STEMICS). This benefit was observed even in elderly patients, suggesting age alone should not prevent this life-saving treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- ST-segment elevation myocardial infarction complicated by cardiogenic shock (STEMICS) carries a high mortality rate.
- Increasing life expectancy leads to more elderly patients with acute myocardial infarction (AMI) undergoing interventions.
- Percutaneous coronary intervention (PCI) is increasingly used in acute myocardial infarction (AMI) patients, including the elderly.
Purpose of the Study:
- To investigate the characteristics of patients with STEMICS.
- To evaluate the impact of PCI on in-hospital mortality in STEMICS patients.
- To assess PCI's effectiveness in elderly STEMICS patients.
Main Methods:
- Retrospective analysis of the Japan AMI Registry (JAMIR) database (2011-2016).
- Comparison of 2760 STEMICS patients: 2396 who underwent PCI versus 364 who did not.
- Subgroup analysis of 789 patients aged ≥80 years.
Main Results:
- In-hospital mortality for STEMICS was 34.6%, with 69.3% receiving mechanical circulatory support.
- PCI was associated with significantly lower in-hospital mortality (31.3% vs. 56.0%, P < 0.001).
- PCI independently reduced in-hospital mortality (adjusted OR, 0.508) and cardiac deaths in elderly patients (adjusted OR, 0.524).
Conclusions:
- PCI is effective in reducing in-hospital cardiac death in elderly patients with STEMICS in Japan.
- Age should not be a barrier to considering PCI in STEMICS patients.
- PCI offers a potentially beneficial invasive therapy for STEMICS, regardless of age.
Aims:
ST-segment elevation myocardial infarction complicated by cardiogenic shock (STEMICS) is associated with substantial mortality. As life expectancy increases, percutaneous coronary intervention (PCI) is being performed more frequently, even in elderly patients with acute myocardial infarction (AMI). This study sought to investigate the characteristics and impact of PCI on in-hospital mortality in patients with STEMICS.
Methods And Results:
The Japan AMI Registry (JAMIR) is a retrospective, nationwide, real-world database. Among 46 242 patients with AMI hospitalized in 2011-2016, 2760 patients with STEMICS (median age, 72 years) were studied. We compared 2396 (86.8%) patients who underwent PCI with 364 (13.2%) patients who did not. The percentage of mechanical circulatory support use in patients with STEMICS was 69.3% and in-hospital mortality was 34.6%. Compared with patients who did not undergo PCI, patients undergoing PCI were younger and had a higher rate of intra-aortic balloon pump use. A higher proportion was male or current smokers. In-hospital mortality was significantly lower in the PCI group than in the no-PCI group (31.3% vs. 56.0%, P < 0.001). Percutaneous coronary intervention was independently associated with lower in-hospital mortality [adjusted odds ratio (OR), 0.508; 95% confidence interval (CI), 0.347-0.744]. In 789 (28.6%) patients aged ≥80 years, PCI was associated with fewer in-hospital cardiac deaths (adjusted OR, 0.524; 95% CI, 0.281-0.975), but was not associated with in-hospital mortality (adjusted OR, 0.564; 95% CI, 0.300-1.050).
Conclusion:
In Japan, PCI was effective in reducing in-hospital cardiac death in elderly patients with STEMICS. Age alone should not preclude potentially beneficial invasive therapy.
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