Reperfusion therapy for older patients with acute myocardial infarction and cardiogenic shock

Reperfusion therapy is the cornerstone of treatment for acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). However, older adults with AMI and CS face higher risks of adverse outcomes and procedure-related complications. Since this population is under-represented in clinical trials, the efficacy of reperfusion therapy remains unclear. We performed a meta-analysis to evaluate the impact of reperfusion therapy on mortality in older adults with AMI and CS.

We searched PUBMED and EMBASE through 4/1/2025 for studies comparing reperfusion therapy with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) and non-reperfusion therapy for AMI and CS in patients aged ≥75 years. We included prospective and retrospective observational trials reporting clinical outcomes. The primary outcome was set as short-term mortality, and the secondary outcome was long-term mortality. We performed subgroup analysis of the primary outcome for patients with ST-segment elevation myocardial infarction and those without.

Our search identified 14 eligible studies in a total of 4583 patients. Reperfusion therapy was associated with significantly reduced short-term mortality, compared with non-reperfusion therapy with high heterogeneity (odds ratio (OR): 0.47; 95% confidence interval (CI): 0.30-0.73, I² = 76.8%). There was no significant difference in long-term all-cause mortality between reperfusion and non-reperfusion therapy (OR: 0.66; 95% CI: 0.34-1.26, I² = 79.7%). The subgroup analyses were largely consistent with the main findings.

Reperfusion therapy was associated with reduced short-term mortality, compared to non-reperfusion therapy for older patients with AMI and CS. Reperfusion therapy showed a tendency towards reduced long-term mortality.