Survival benefit from early revascularization in elderly patients with cardiogenic shock after acute myocardial infarction: a cohort study.
OBJECTIVE
To assess if early revascularization offers any survival benefit in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) who are > or = 75 years of age.


BACKGROUND
CS after AMI continues to pose formidable therapeutic challenges in elderly patients.


METHODS
We conducted survival analyses of 310 consecutive subjects (including 80 patients > or = 75 years of age) who developed cardiogenic shock after AMI at two study centers - Rush University Medical Center and the John H. Stroger Jr. Hospital of Cook County (both in Chicago, Illinois). The data were collected over a 6-year period. Where appropriate, we used Kaplan-Meier survival plots, multivariate Cox proportional hazards modeling, stepwise multivariate Poisson regression analyses and unconditional logistic regression analysis.


RESULTS
Early revascularization was associated with a statistically significant survival benefit both in patients < 75 years of age (relative hazard 0.40, 95% confidence interval [CI] 0.28-0.59; p < 0.001), as well as in patients > or = 75 years of age (relative hazard 0.56, 95% CI 0.32-0.99; p = 0.049). This benefit remained significant even after adjusting for the simultaneous effects of several putative confounders. In patients > or = 75 years of age, this survival benefit was evident very early and was sustained all through the period of follow up of the cohort.


CONCLUSIONS
These retrospective data suggest a significant survival benefit of early revascularization in elderly patients > or = 75 years of age developing CS after AMI, albeit less as compared to those aged < 75 years.
Amin
Amit P
AP
John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA. amit_p_amin@yahoo.com
Nathan
Sandeep
S
Prodduturi
Prathima
P
D'Silva
Oliver
O
Gupta
Akshay
A
Kumar
Arun
A
Senter
Shaun
S
Mamtani
Manju
M
Kulkarni
Hemant
H
Klein
Lloyd W
LW
Kelly
Russell F
RF
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007087:Illinois; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy; D009204:Myocardial Revascularization; D012044:Regression Analysis; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000628:therapy; D013997:Time Factors; D014481:United States