Long-term survival of elderly patients undergoing percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock.
Int J Cardiol. 2015 May 22;195:259-264
Authors: Lim HS, Andrianopoulos N, Sugumar H, Stub D, Brennan AL, Lim CC, Barlis P, Van Gaal W, Reid CM, Charter K, Sebastian M, New G, Ajani AE, Farouque O, Duffy SJ, Clark DJ, Melbourne Interventional Group
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 ≥75years) 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±1.8years.
RESULTS: Of the 421 consecutive patients, 122 patients were elderly (≥75years) and 299 patients were younger (<75years). 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.
PMID: 26048389 [PubMed - as supplied by publisher]