TY - JOUR
T1 - Impact of Age in Acute Myocardial Infarction Cardiogenic Shock
T2 - Insights From the National Cardiogenic Shock Initiative
AU - Lemor, Alejandro
AU - Basir, Mir B.
AU - Gorgis, Sarah
AU - Todd, Josh
AU - Marso, Steve
AU - Gelormini, Joseph
AU - Akhtar, Yasir
AU - Baker, John
AU - Chahin, Juan
AU - Abdul-Waheed, Mohammad
AU - Thukral, Nandish
AU - O'Neill, William
N1 - Funding Information:
The NCSI is funded by unrestricted research grants from Abiomed and Chiesi Pharmaceuticals Inc. Neither company had direct involvement in the study design nor the present analysis. Dr Basir has the following disclosures: Abbott Vascular, Abiomed, Chiesi, Cardiovascular Systems, and Zoll; and Dr O’Neill has the following disclosures: Abiomed and Abbott. The rest of the authors have nothing to declare.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background: Acute myocardial infarction complicated by cardiogenic shock (AMICS) is associated with high mortality. Patients ≥75 years old represent an increasing proportion of those who present with AMICS and are at high risk for adverse outcomes. Methods: The National Cardiogenic Shock Initiative includes patients with AMICS treated using a standard shock protocol with early invasive hemodynamic monitoring, mechanical circulatory support (MCS), and percutaneous coronary intervention (PCI). We evaluated the outcomes of patients based on their age group, dividing them into <75 and ≥75 years old. Results: We included 300 consecutive patients: 238 were <75 years old (79.3%) and 62 patients ≥75 years old. There were significant differences in survival; patients <75 years old had a 75.6% survival, while those ≥75 years old had a 50% survival (adjusted OR: 10.4, P = 0.001). SCAI shock classification impacted survival as well; those <75 years old with class C or D shock had a survival of 84%, compared with 57% in those ≥75 years old. Patients ≥75 years old requiring 1 or 2 vasopressors had significantly lower survival rates (36% and 25%, respectively) when compared with patients <75 years old (76.7% with 1 and 60.5% with >1 vasopressor). Conclusions: Age is inversely proportional to survival; patients <75 years old have high rates of survival if treated using best practices with invasive hemodynamic monitoring, early MCS, and PCI. However, using a standardized protocol can improve survival in the elderly; therefore, age on its own should not be a reason to withhold PCI or MCS use.
AB - Background: Acute myocardial infarction complicated by cardiogenic shock (AMICS) is associated with high mortality. Patients ≥75 years old represent an increasing proportion of those who present with AMICS and are at high risk for adverse outcomes. Methods: The National Cardiogenic Shock Initiative includes patients with AMICS treated using a standard shock protocol with early invasive hemodynamic monitoring, mechanical circulatory support (MCS), and percutaneous coronary intervention (PCI). We evaluated the outcomes of patients based on their age group, dividing them into <75 and ≥75 years old. Results: We included 300 consecutive patients: 238 were <75 years old (79.3%) and 62 patients ≥75 years old. There were significant differences in survival; patients <75 years old had a 75.6% survival, while those ≥75 years old had a 50% survival (adjusted OR: 10.4, P = 0.001). SCAI shock classification impacted survival as well; those <75 years old with class C or D shock had a survival of 84%, compared with 57% in those ≥75 years old. Patients ≥75 years old requiring 1 or 2 vasopressors had significantly lower survival rates (36% and 25%, respectively) when compared with patients <75 years old (76.7% with 1 and 60.5% with >1 vasopressor). Conclusions: Age is inversely proportional to survival; patients <75 years old have high rates of survival if treated using best practices with invasive hemodynamic monitoring, early MCS, and PCI. However, using a standardized protocol can improve survival in the elderly; therefore, age on its own should not be a reason to withhold PCI or MCS use.
KW - >75 years old
KW - acute myocardial infarction
KW - cardiogenic shock
KW - elderly
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U2 - 10.1097/HPC.0000000000000255
DO - 10.1097/HPC.0000000000000255
M3 - Article
C2 - 33606413
AN - SCOPUS:85113823069
SN - 1535-282X
VL - 20
SP - 163
EP - 167
JO - Critical pathways in cardiology
JF - Critical pathways in cardiology
IS - 3
ER -