Routine percutaneous coronary intervention in elderly patients with cardiogenic shock complicating acute myocardial infarction

BackgroundAge is a strong predictor of cardiogenic shock (CS) and death in patients with acute myocardial infarction (AMI). Few data on the impact of a routine early percutaneous revascularization strategy in elderly patients with CS complicating AMI exist.MethodsWe performed an analysis of age-related differences in outcome in 280 consecutive patients with AMI complicated by CS who underwent primary percutaneous coronary intervention (PCI) between January 1995 and September 2004 and who were included in a single-center prospective registry of primary PCI for AMI.ResultsOf the 280 patients with CS, 104 (37%) were ≥75 years. The mean age of the elderly group was 81 ± 5 years, and half of the patients were ≥80 years. Most patients in both groups underwent PCI within 6 hours of their symptom onset. The PCI success rates were 92% in the elderly group and 97% in the younger patient group (P = .062). The 6-month mortality rates were 56% in the elderly group and 26% in the younger patient group (P < .001). At multivariate analysis, the variables independently related to the risk of 1-year mortality in the elderly group were age (hazard ratio 1.07, 95% CI 1.02-1.12, P = .005) and PCI failure (hazard ratio 4.01, 95% CI 1.53-10.51, P = .005).ConclusionA strategy of routine emergency PCI in elderly patients with CS complicating AMI is highly feasible. Among elderly patients, age remains to be a strong predictor of mortality. However, outcome after successful PCI is better than previously reported.