title: Long-term survival of elderly patients undergoing percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock.
abstract: BACKGROUND
  The long-term benefit of early percutaneous coronary intervention (PCI) for cardiogenic shock (CS) in elderly patients remains unclear. We sought to assess the long-term survival of elderly patients (age ≥ 75 years) with myocardial infarction (MI) complicated by CS undergoing PCI.
  
  
  METHODS
  We analyzed baseline characteristics, early outcomes, and long-term survival in 421 consecutive patients presenting with MI and CS who underwent PCI from the Melbourne Interventional Group registry from 2004 to 2011. Mean follow-up of patients who survived to hospital discharge was 3.0 ± 1.8 years.
  
  
  RESULTS
  Of the 421 consecutive patients, 122 patients were elderly (≥ 75 years) and 299 patients were younger (< 75 years). The elderly cohort had significantly more females, peripheral and cerebrovascular disease, renal impairment, heart failure (HF) and prior MI (all p < 0.05). Procedural success was lower in the elderly (83% vs. 92%, p < 0.01). Long-term mortality was significantly higher in the elderly (p < 0.01), driven by high in-hospital mortality (48% vs. 36%, p < 0.05). However, in a landmark analysis of hospital survivors in the elderly group, long-term mortality rates stabilized, approximating younger patients with CS (p = 0.22). Unsuccessful procedure, renal impairment, HF and diabetes mellitus were independent predictors of long-term mortality. However, age ≥ 75 was not a significant predictor (HR 1.2; 95% CI 0.9-1.7; p = 0.2).
  
  
  CONCLUSIONS
  Elderly patients with MI and CS have lower procedural success and higher in-hospital mortality compared to younger patients. However, comparable long-term survival can be achieved, especially in patients who survive to hospital discharge with the selective use of early revascularization.
authors.affiliation: Department of Cardiology, Austin Hospital, Melbourne, Australia; Department of Cardiology, Northern Hospital, Melbourne, Australia.
authors.forename: Han S
authors.initials: HS
authors.lastname: Lim
authors.affiliation: Monash Centre for Cardiovascular Research & Education in Therapeutics (CCRE), Monash University, Melbourne, Australia & School of Public Health, Curtin University, Perth, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Andrianopoulos
authors.affiliation: Department of Cardiology, Austin Hospital, Melbourne, Australia.
authors.forename: Hariharan
authors.initials: H
authors.lastname: Sugumar
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Australia.
authors.forename: Dion
authors.initials: D
authors.lastname: Stub
authors.affiliation: Monash Centre for Cardiovascular Research & Education in Therapeutics (CCRE), Monash University, Melbourne, Australia & School of Public Health, Curtin University, Perth, Australia.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Brennan
authors.affiliation: Department of Cardiology, Northern Hospital, Melbourne, Australia.
authors.forename: Chris C S
authors.initials: CC
authors.lastname: Lim
authors.affiliation: Department of Cardiology, Northern Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Barlis
authors.affiliation: Department of Cardiology, Northern Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Van Gaal
authors.affiliation: Monash Centre for Cardiovascular Research & Education in Therapeutics (CCRE), Monash University, Melbourne, Australia & School of Public Health, Curtin University, Perth, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: Department of Cardiology, Austin Hospital, Melbourne, Australia.
authors.forename: Kerrie
authors.initials: K
authors.lastname: Charter
authors.affiliation: Department of Cardiology, Geelong Hospital, Melbourne, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Sebastian
authors.affiliation: Department of Cardiology, Box Hill Hospital, Melbourne, Australia.
authors.forename: Gishel
authors.initials: G
authors.lastname: New
authors.affiliation: Monash Centre for Cardiovascular Research & Education in Therapeutics (CCRE), Monash University, Melbourne, Australia & School of Public Health, Curtin University, Perth, Australia; University of Melbourne, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ajani
authors.affiliation: Department of Cardiology, Austin Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
authors.forename: Omar
authors.initials: O
authors.lastname: Farouque
authors.affiliation: Monash Centre for Cardiovascular Research & Education in Therapeutics (CCRE), Monash University, Melbourne, Australia & School of Public Health, Curtin University, Perth, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Duffy
authors.affiliation: Department of Cardiology, Austin Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia. Electronic address: clarkdavidj@hotmail.com.
authors.forename: David J
authors.initials: DJ
authors.lastname: Clark
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D051437:Renal Insufficiency / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology*; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*
keywords: Cardiogenic shock; Early revascularization; Elderly; Mortality