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Survival of Elderly Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction Complicated by Cardiogenic Shock

Han S. Lim, MBBS^_*,_**, Omar Farouque, MBBS, FRACP, PhD, FACC^_*,, Nick Andrianopoulos, MBBS, MBiostat, Bryan P. Yan, MBBS, FRACP^,, Chris C.S. Lim, MBBS^||, Angela L. Brennan, RN, CCRN, Chris M. Reid, BA, MSc, DipEd, PhD, Melanie Freeman, MBBS^_*, Kerrie Charter, RN, CCRN^_*, Alexander Black, MBBS, FRACP^,,¶, Gishel New, MBBS, FRACP, PhD, FACC^||, Andrew E. Ajani, MBBS, FRACP, FJFICM, MD^,,, Stephen J. Duffy, MBBS, MRCP, FRACP, PhD^#, David J. Clark, MBBS, FRACP^_*,_* on behalf of the Melbourne Interventional Group

^_* Department of Cardiology, Austin Hospital, Melbourne, Australia
University of Melbourne, Melbourne, Australia
Monash Centre for Cardiovascular Research & Education in Therapeutics, Monash University, Melbourne, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
^|| Department of Cardiology, Box Hill Hospital, Melbourne, Australia
^¶ Department of Cardiology, Geelong Hospital, Melbourne, Australia
^# Department of Cardiology, Alfred Hospital, Melbourne, Australia
^_** Discipline of Physiology, School of Molecular and Biomedical Science, University of Adelaide, Adelaide, Australia
Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Chinese University of Hong Kong, Hong Kong, China

^_* Reprint requests and correspondence: Dr. David J. Clark, Austin Health, Cardiology, PO Box 5555, 145 Studley Road, Heidelberg, Melbourne, Victoria 3084, Australia (Email: clarkdavidj{at}hotmail.com).

Objectives: We sought to assess clinical outcomes of elderly patients (age 75 years) undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) complicated by cardiogenic shock (CS) in a contemporary multicenter PCI registry.

Background: Although benefits of early PCI have been shown in younger groups, few studies have reported on clinical outcomes in elderly shock patients using current PCI techniques.

Methods: We analyzed baseline characteristics and procedural and clinical outcomes in 143 consecutive patients presenting with MI and CS who underwent PCI from the Melbourne Interventional Group registry between 2004 and 2007.

Results: Of the 143 patients, 31.5% (n = 45) were elderly and 68.5% were younger (age <75 years). Elderly patients were more likely to be female (46.7% vs. 22.4%, p < 0.01) and have hypertension (77.8% vs. 46.4%, p < 0.01), previous MI (31.1% vs. 15.5%, p = 0.03), renal failure (24.4% vs. 11.3%, p < 0.05) and multivessel coronary artery disease (93.1% vs. 68.3%, p < 0.01). Stent (86.7% vs. 94.8%, p = 0.09), glycoprotein IIb/IIIa inhibitor (68.9% vs. 65.3%, p = 0.67), and intra-aortic balloon pump (57.8% vs. 58.2%, p = 0.97) use were similar in both groups. In-hospital, 30-day, and 1-year mortality in the elderly group versus the younger group were 42.2% vs. 33.7% (p = 0.32), 43.2% vs. 36.1% (p = 0.42), and 52.6% vs. 46.8% (p = 0.56), respectively.

Conclusions: In this study, the 1-year survival of elderly patients with acute MI complicated by CS undergoing PCI was comparable to younger patients. These data suggest that in elderly patients presenting with CS, benefit is possible with selective use of early revascularization and merits further investigation.

Key Words: cardiogenic shock • elderly • acute myocardial infarction • percutaneous coronary intervention

Abbreviations and Acronyms   CS = cardiogenic shock   MACE = major adverse cardiac events   MI = myocardial infarction   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction   TVR = target vessel revascularization

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