Outcomes of elderly patients with cardiogenic shock treated with early percutaneous revascularization.
BACKGROUND
Subgroup analysis from the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial indicated that patients with acute myocardial infarction (MI) complicated by cardiogenic shock (CS) who were > or =75 years old did not benefit from early revascularization and may have been harmed; their mortality rate at 30 days was 75%. The applicability of this subset analysis from a select patient population enrolled in a randomized trial to the general population is unclear.


METHODS
At the Mayo Clinic between 1991 and 2000, we evaluated the outcome of all patients > or =75 years old with CS caused by MI who underwent urgent percutaneous coronary intervention (PCI).


RESULTS
The study included 61 patients with a mean age of 79.5 +/- 3 years; 21% of these patients had a history of prior coronary artery bypass grafting (CABG), 41% had had a prior MI, 28% had diabetes mellitus, and 18% had a history of a cerebrovascular accident (CVA). PCI was performed 8.0 +/- 7.2 hours after onset of MI. Angiographic success (<50% residual stenosis) was achieved in 91% of the lesions that were dilated. In hospital outcomes included death (44%), CABG (1.6%), and CVA (4.9%). The 30-day mortality rate was 47%. The estimated survival rate 1 year after discharge (Kaplan Meier method) was 75%.


CONCLUSIONS
These data confirm a high early mortality rate among patients > or =75 years old with MI complicated by CS, but suggest that among patients referred for angiography, outcomes may be better than previously believed when early revascularization is performed. In this population, 56% of patients survived to be discharged from the hospital, and of the hospital survivors, 75% were alive at 1 year.
Prasad
Abhiram
A
Division of Cardiovascular Diseases and Department of Internal Medicine, Rochester, Minn, USA.
Lennon
Ryan J
RJ
Rihal
Charanjit S
CS
Berger
Peter B
PB
Holmes
David R
DR
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D017023:Coronary Angiography; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D012907:Smoking / Q000453:epidemiology; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome