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
 |
Abstract
|
|---|
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 |
|
The elderly constitute an increasing proportion of patients presenting with acute myocardial infarction (MI) (1–3), and advanced age is a strong predictor of adverse outcomes (4–6). Cardiogenic shock (CS) complicates approximately 5% to 8% of patients presenting with ST-segment elevation MI (STEMI) (7–9) and remains the leading cause of death after hospitalization (10–12). Studies have shown a benefit of percutaneous coronary intervention (PCI) in patients presenting with acute MI complicated by CS (13–16). However, in the randomized SHOCK (SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?) trial (17), the benefit of revascularization was limited to patients <75 years of age, with this subgroup analysis limited by a small number of elderly patients (17,18).
The aim of this study was to evaluate the clinical characteristics, lesion features, procedural details, and clinical outcomes of elderly patients 75 years old compared with patients <75 years old undergoing PCI for acute MI complicated by CS in a large, contemporary multicenter PCI registry.
|
Methods
|
|---|
Study population.
There were 3,025 patients with acute MI in the MIG (Melbourne Interventional Group) registry who underwent PCI from April 1, 2004, to December 10, 2007, including both STEMI and non-STEMI. Of these patients, 143 (4.7%) presented with CS and were categorized into 2 groups, the elderly group (age 75 years, n = 45), and the younger group (age <75 years, n = 98).
Data collection and registry design.
The MIG registry is a collaborative PCI registry comprising 7 Australian public referral hospitals; it is designed to record prospective data of all PCI procedures. The MIG registry has been previously described in detail (19,20). Baseline demographics and clinical, angiographic, and procedural characteristics of consecutive patients undergoing PCI are prospectively recorded on case report forms using standardized definitions for all fields (20). The study protocol has been approved by the ethics committee in each participating hospital, and "opt-out" informed consent was obtained in all patients (19).
In-hospital outcomes and complications were recorded at the time of discharge. Cardiac research nurses conducted 30-day and 12-month follow-up by telephone, using a standardized questionnaire (19). All adverse events were confirmed by reviewing the patients' medical records at the relevant hospitals.
The registry is coordinated by the Centre for Cardiovascular Research & Education in Therapeutics, a research body within the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. An independent audit was conducted at all enrolling sites by an investigator not affiliated with that institution, in which 10 verifiable fields from 3% of all patients enrolled from each site were randomly selected and audited. Data accuracy was 97%, which is comparable to other large registries (21).
Definitions and outcomes.
Acute MI was defined as STEMI or non-STEMI. We defined STEMI as the presence of at least 0.1-mV ST-segment elevation or new pathological Q waves in 2 contiguous electrocardiogram leads or new left bundle branch block with elevation of cardiac enzyme levels above the reference range. Non-STEMI was defined by the presence of ST-segment depression or T-wave abnormalities or ischemic symptoms with elevation of cardiac enzyme levels above the reference range.
Cardiogenic shock was defined as a systolic blood pressure of <90 mm Hg for at least 30 min or the need for supportive measures to maintain a systolic blood pressure 90 mm Hg associated with end-organ hypoperfusion (cool extremities or a urine output of <30 ml/h, and a heart rate of 60 beats/min). Hemodynamic criteria were a cardiac index of no more than 2.2 l/min/m2 of body surface area and a pulmonary capillary wedge pressure of at least 15 mm Hg.
In-hospital outcomes included all-cause mortality; periprocedural MI, defined as new MI during or after the catheterization laboratory visit with at least 1 instance of elevation of creatine kinase/creatine kinase-myocardial band more than 3 times the upper limit of normal and/or evolutionary ST-segment elevation, development of new Q waves in 2 or more contiguous electrocardiography leads, or new left bundle branch block pattern on the electrocardiogram; bleeding, defined as requiring a transfusion and/or prolonged hospital stay and/or causing a drop in hemoglobin >3.0 g/dl; congestive heart failure; renal failure, defined as an increase of creatinine to >0.20 mmol/l and 2 times the baseline creatinine level or a new requirement for dialysis; stroke; emergency PCI; and emergency coronary artery bypass graft surgery.
The 30-day and 1-year outcomes included all-cause mortality, cardiac and noncardiac deaths, MI, target lesion revascularization, and target vessel revascularization (TVR), defined as repeat revascularization within 5 mm of the treated segment and repeat revascularization of the treated vessel, respectively. Major adverse cardiac events (MACE) were a composite of death, MI, and TVR.
Statistical analysis.
Continuous variables were expressed as mean ± standard deviation, and categorical data expressed as percentages, except where indicated. Continuous variables were compared using Student t tests or analysis of variance as appropriate. Categorical variables were compared using Fisher's exact or Pearson's chi-square tests as appropriate. All calculated p values were 2-sided and p values <0.05 were considered statistically significant. Cumulative incidence of mortality and MACE was estimated according to the Kaplan-Meier method and the log-rank test was used to evaluate differences between groups.
Univariate and multivariate logistic regression analyses were used to determine independent predictors of in-hospital mortality. Variables used were age 75 years, gender, diabetes mellitus, hypertension, dyslipidemia, renal failure, family history of coronary artery disease, previous MI, smoking status, STEMI, left main procedure, proximal lesions, bypass graft lesions, American College of Cardiology and American Heart Association type B2 and C lesions, ostial lesions, bifurcation lesions, use of glycoprotein IIb/IIIa inhibitors, intra-aortic balloon pump use, drug-eluting stent use, stent length 20 mm, and stent diameter  2.5 mm. All univariate predictors with p < 0.10, and age group were then added to a multivariate model. All statistical analyses were performed using SPSS version 15.0 for Windows (SPSS Inc., Chicago, Illinois).
|
Results
|
|---|
Baseline characteristics.
The mean age of the elderly group was 79.8 ± 3.6 years and the mean age of the younger group was 61.4 ± 9.4 years. The percentage of STEMI presentations was 75.6% in the elderly group and 78.6% in the younger group. Elderly patients were more likely to be female and have hypertension, previous MI, renal failure, and multivessel coronary artery disease, as shown in Table 1. There was a trend toward more cerebrovascular disease in the elderly group. There were more current smokers in the younger group.
View this table:
[in this window]
[in a new window]
|
Table 1 Baseline Characteristics of the Elderly Group (Age 75 Years) Versus the Younger Group (Age <75 Years) Who Underwent PCI for Acute MI Complicated by CS
|
|
Among the STEMI patients, there was no significant difference in the time from symptom onset to balloon inflation or door-to-balloon time between the 2 age groups (Table 1), with a similar proportion of patients presenting very late (>24 h after onset of symptoms) in both groups.
Lesion characteristics and procedural details.
There was a higher proportion of multivessel coronary artery disease in the elderly group (Table 2). There were no significant differences in the distribution of target vessel lesions and American College of Cardiology/American Heart Association lesion types. Both the elderly and the younger groups were treated with a similar proportion of stents, drug-eluting stents, glycoprotein IIb/IIIa receptor inhibitors, and intra-aortic balloon pump use. There was a similar rate of Thrombolysis In Myocardial Infarction (TIMI) flow grades 2 or 3 after the procedure.
Clinical outcomes.
In-hospital, 30-day, and 1-year outcomes were available in 100%, 98.6%, and 81.8% of patients, respectively. There were 23 (16%) patients not yet eligible for 1-year follow-up at the time of analysis and 3 (2%) were lost to follow-up.
In-hospital mortality was 42.2% in the elderly group compared with 33.7% in the younger group (p = 0.32) (Table 3). Renal failure was a frequent complication among the elderly patients (28.9% vs. 12.2%, p = 0.02). Congestive cardiac failure occurred in 40% of elderly patients versus 25.5% in the younger group (p = 0.08). Periprocedural MI, emergency PCI, unplanned coronary artery bypass graft, bleeding, and stroke complications were not significantly different between the 2 groups.
The 30-day mortality was 43.2% in the elderly group compared with 36.1% in the younger group (p = 0.42). The 1-year mortality was 52.6% in the elderly group compared with 46.8% in the younger group (p = 0.56). There were no significant differences in 30-day or 1-year MACE, MI, target lesion revascularization, and TVR rates. Kaplan-Meier curves of 1-year survival and freedom from MACE between the 2 groups are shown in Figures 1 and 2.
View larger version (11K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2 Kaplan-Meier Estimates of Cumulative 1-Year Freedom From MACE
Kaplan-Meier estimates of cumulative 1-year freedom from MACE, including death, myocardial infarction, and target vessel revascularization, in patients age 75 years versus <75 years.
|
|
Predictors of outcome.
Univariate predictors of in-hospital mortality with p < 0.10 were the presence of diabetes (p = 0.05), hypertension (p = 0.02), renal failure (p < 0.01), STEMI (p = 0.03), and intra-aortic balloon pump use (p = 0.04). Age 75 years was not a predictor (p = 0.33). Renal failure was the only significant multivariate predictor of in-hospital mortality with an odds ratio of 3.41 (95% confidence interval: 1.21 to 9.63; p = 0.02), as shown in Table 4.
|
Discussion
|
|---|
In this study of cardiogenic shock in the setting of MI, elderly patients selected for revascularization had a higher risk profile, including being female and having renal impairment, previous MI, and multivessel coronary artery disease. In spite of this, survival rates of the elderly in-hospital and at 1-year were not significantly different from the survival rates of a younger group. In addition, rates of MI, target-lesion revascularization, TVR, and MACE were similar between the 2 age groups.
In the SHOCK trial (17), patients with STEMI complicated by CS were randomly assigned to emergency revascularization or initial medical stabilization. The study reported a lower 6-month mortality rate with revascularization than in the medical therapy group (50.3% vs. 63.1%, p = 0.027). However, subgroup analyses showed that this benefit did not extend to patients 75 years old who experienced a 75% 30-day mortality with revascularization compared with 53.1% with medical therapy (p = 0.16). Importantly, the patient numbers were small (only 12 patients 75 years of age underwent early PCI and another 12 had coronary artery bypass graft surgery) (17,22).
Several larger observational studies have shown benefits of early revascularization in the elderly with CS (23–32). Within the large SHOCK registry (1993 to 1997) (23), which included 277 elderly patients, the in-hospital mortality of patients 75 years old was 48% with early revascularization (within 18 h of MI) compared with 81% in the late or no revascularization group (p = 0.0002). Among patients who underwent PCI, there was no difference in in-hospital mortality between age groups (49% 75 years and 47% <75 years) but only a small percentage of elderly patients underwent PCI (15.9%, n = 39). A secondary analysis was performed in that study by excluding patients who died within 3 h of presentation, yielding an in-hospital mortality rate of 48% among elderly patients receiving early revascularization compared with 79% without early revascularization (23). Similarly, a study of CS by the Mayo Clinic between 1991 and 2000 evaluated patients 75 years old (n = 61) undergoing urgent PCI and the in-hospital mortality rate was 44% with a 30-day mortality of 47% (27).
Conversely, the ALKK (Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte) European PCI registry (26) of 1,333 patients with CS found older age was an independent predictor of death and in-hospital mortality in patients >75 years was 63%. An analysis of the ACC-NCDR (American College of Cardiology–National Cardiovascular Data Registry) database of 483 patients undergoing PCI for CS from 1998 to 2002, found age along with female sex, renal insufficiency, total left anterior descending artery occlusion, no stent deployment, and no glycoprotein IIb/IIIa inhibitor use to be independent mortality predictors (6). A summary of these studies and outcome after PCI is presented in Table 5.
Why was the survival of elderly patients in our contemporary PCI study more favorable than in previous reports (17,23–34)? One possible explanation is the high rate of early reperfusion, with a median symptom-to-balloon time for elderly CS STEMI patients of 228 min. Greater than 50% of patients (in both age groups) had a symptom-to-PCI time of less than 6 h. Previous studies have shown that reperfusion time is especially important for survival in patients with CS compared with those without CS (25,35). Time from symptom onset to PCI was longer in both the SHOCK trial and ALKK registry. Another reason is likely related to the high rate of stent deployment (86.7% vs. 34% in the SHOCK trial) (17,22) and glycoprotein IIb/IIIa inhibitor use (36,37) (68.9% vs. 32% in the SHOCK trial) (22) in our 75 year olds when compared with the previous studies. Notably, in the elderly patients, stents were predominantly deployed in the culprit vessel only, despite a high incidence of multivessel disease. These temporal and procedural factors may also account for the fact that 92.3% of our elderly patients had TIMI flow grades 2 or 3 at the completion of the procedure compared with 81.8% in the SHOCK registry (23) and only 58% in the randomized SHOCK trial (22).
Study limitations.
This study was a nonrandomized, observational study and multivariate analyses may not have fully accounted for the unmatched differences in baseline characteristics between the 2 groups. The number of elderly patients who underwent PCI were limited, an issue common to all studies of CS (Table 5). A larger sample size would improve the likelihood of determining whether significant differences in outcome between elderly and younger patients exist. The favorable outcomes after PCI in the elderly group may have been influenced by physician selection bias for patients deemed most likely to benefit from PCI, and exclusion of those patients in whom invasive treatment was deemed clinically futile.
|
Conclusions
|
|---|
In this study, 1-year survival of elderly patients with acute MI complicated by CS undergoing PCI using contemporary techniques was comparable with survival rates of younger patients. These data suggest that elderly patients presenting with CS may benefit from selective use of early revascularization and merits further investigation.
|
Appendix
|
|---|
For a list of the Melbourne Interventional Group Investigators, please see the online version of this article.
|
Footnotes
|
|---|
The Melbourne Interventional Group acknowledges funding from Abbott Vascular, AstraZeneca, Biotronik, Boston Scientific, Johnson & Johnson, Medtronic, Pfizer, Schering-Plough, Sanofi-Aventis, Servier, St. Jude Medical, and Terumo. These companies do not have access to the data, and do not have the right to review articles before publication. Dr. Duffy's work is supported by a National Health and Medical Research Council of Australia Program Grant.
* 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).
Manuscript received June 27, 2008;
revised manuscript received October 14, 2008,
accepted November 7, 2008.
|
REFERENCES
|
|---|
- Furman MI, Dauerman HL, Goldberg RJ, Yarzebski J, Lessard D, Gore JM. Twenty-two year (1975 to 1997) trends in the incidence, in-hospital and long-term case fatality rates from initial Q-wave and non–Q-wave myocardial infarction: a multi-hospital, community-wide perspective J Am Coll Cardiol 2001;37:1571-1580.[Abstract/Free Full Text]
- Goldberg RJ, Yarzebski J, Lessard D, Gore JM. A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case-fatality rates of acute myocardial infarction: a community-wide perspective J Am Coll Cardiol 1999;33:1533-1539.[Abstract/Free Full Text]
- The TIME Investigators Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomized trial Lancet 2001;358:951-957.[CrossRef][Web of Science][Medline]
- Singh M, White J, Hasdai D, et al. Long-term outcome and its predictors among patients with ST-segment elevation myocardial infarction complicated by shock. Insights from the GUSTO-I trial. J Am Coll Cardiol 2007;50:1752-1758.[Abstract/Free Full Text]
- Hasdai D, Topol EJ, Califf RM, Berger PB, Holmes Jr DR. Cardiogenic shock complicating acute coronary syndromes Lancet 2000;356:749-756.[CrossRef][Web of Science][Medline]
- Klein LW, Shaw RE, Krone RJ, et al. American College of Cardiology National Cardiovascular Data Registry Mortality after emergent percutaneous coronary intervention in cardiogenic shock secondary to acute myocardial infarction and usefulness of a mortality prediction model Am J Cardiol 2005;96:35-41.[Web of Science][Medline]
- Reynolds HR, Hochman JS. Cardiogenic shock: current concepts and improving outcomes Circulation 2008;117:686-697.[Free Full Text]
- Fox KA, Anderson Jr. FA, Dabbous OH, et al. GRACE Investigators Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE) Heart 2007;93:177-182.[Abstract/Free Full Text]
- Babaev A, Frederick PD, Pasta DJ, et al. NRMI Investigators Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock JAMA 2005;294:448-454.[Abstract/Free Full Text]
- Goldberg RJ, Gore JM, Alpert JS, et al. Cardiogenic shock after acute myocardial infarction: incidence and mortality from a community-wide perspective, 1975 to 1988 N Engl J Med 1991;325:1117-1122.[Abstract]
- Holmes Jr. DR, Bates ER, Kleiman NS, et al. Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience J Am Coll Cardiol 1995;26:668-674.[Abstract]
- Goldberg RJ, Samad NA, Yarzebski J, et al. Temporal trends in cardiogenic shock complicating acute myocardial infarction N Engl J Med 1999;340:1162-1168.[Abstract/Free Full Text]
- Antoniucci D, Valenti R, Santoro GM, et al. Systematic direct angioplasty therapy for cardiogenic shock complicating acute myocardial infarction: in-hospital and long-term survival J Am Coll Cardiol 1998;31:294-300.[Abstract/Free Full Text]
- Hibbard MD, Holmes Jr. DR, Bailey KR, et al. Percutaneous transluminal coronary angioplasty in patients with cardiogenic shock J Am Coll Cardiol 1992;19:639-646.[Abstract]
- Dzavík V, Burton JR, Kee C, et al. Changing patterns of practice in management of acute myocardial infarction complicated by cardiogenic shock: elderly compared with younger patients Can J Cardiol 1998;14:923-930.[Web of Science][Medline]
- Ajani AE, Maruff P, Warren R, et al. Impact of early percutaneous coronary intervention on short- and long-term outcomes in patients with cardiogenic shock after acute myocardial infarction Am J Cardiol 2001;87:633-635.[CrossRef][Web of Science][Medline]
- Hochman JS, Sleeper LA, Webb JG, et al. SHOCK Investigators Early revascularization in acute myocardial infarction complicated by cardiogenic shock N Engl J Med 1999;341:625-634.[Abstract/Free Full Text]
- Gurwitz JH, Col NF, Avorn J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction JAMA 1992;268:1417-1422.[Abstract/Free Full Text]
- Ajani AE, Szto G, Duffy SJ, et al. Melbourne Interventional Group Investigators The foundation and launch of the Melbourne Interventional Group: a collaborative interventional cardiology project Heart Lung Circ 2006;15:44-47.[CrossRef][Medline]
- Yan BP, Ajani AE, Duffy SJ, et al. Use of drug-eluting stents in Victorian public hospitals Med J Aust 2006;185:363-367.[Web of Science][Medline]
- Lagerqvist B, James SK, Stenestrand U, et al. SCAAR Study Group Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden N Engl J Med 2007;356:1009-1019.[Abstract/Free Full Text]
- Webb JG, Lowe AM, Sanborn TA, et al. SHOCK Investigators Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial J Am Coll Cardiol 2003;42:1380-1386.[Abstract/Free Full Text]
- Dzavik V, Sleeper LA, Cocke TP, et al. SHOCK Investigators Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock: a report from the SHOCK Trial Registry Eur Heart J 2003;24:828-837.[Abstract/Free Full Text]
- Migliorini A, Moschi G, Valenti R, et al. Routine percutaneous coronary intervention in elderly patients with cardiogenic shock complicating acute myocardial infarction Am Heart J 2006;152:903-908.[CrossRef][Web of Science][Medline]
- Antoniucci D, Valenti R, Migliorini A, et al. Comparison of impact of emergency percutaneous revascularization on outcome of patients 75 years of age with acute myocardial infarction complicated by cardiogenic shock Am J Cardiol 2003;91:1458-1461.[CrossRef][Web of Science][Medline]
- Zeymer U, Vogt A, Zahn R, et al. Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) Predictors of in-hospital mortality in 1,333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI): results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) Eur Heart J 2004;25:322-328.[Abstract/Free Full Text]
- Prasad A, Lennon RJ, Rihal CS, Berger PB, Holmes Jr DR. Outcomes of elderly patients with cardiogenic shock treated with early percutaneous revascularization Am Heart J 2004;147:1066-1070.[CrossRef][Web of Science][Medline]
- Dauerman HL, Ryan Jr. TJ, Piper WD, et al. Outcomes of percutaneous coronary intervention among elderly patients in cardiogenic shock:a multicenter, decade-long experience J Invasive Cardiol 2003;15:380-384.[Medline]
- Dzavik V, Sleeper LA, Picard MH, et al. SHOCK Investigators Outcome of patients aged 75 years in the SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK (SHOCK) trial: Do elderly patients with acute myocardial infarction complicated by cardiogenic shock respond differently to emergent revascularization? Am Heart J 2005;149:1128-1134.[CrossRef][Web of Science][Medline]
- Dauerman HL, Goldberg RJ, Malinski M, Yarzebski J, Lessard D, Gore JM. Outcomes and early revascularization for patients 65 years of age with cardiogenic shock Am J Cardiol 2001;87:844-848.[CrossRef][Web of Science][Medline]
- French JK. Which elderly patients with cardiogenic shock should be treated with percutaneous coronary intervention? Am Heart J 2004;147:950-952.[CrossRef][Web of Science][Medline]
- Hasdai D. Should we aggressively treat elderly patients with cardiogenic shock? Am Heart J 2005;149:962-963.[CrossRef][Web of Science][Medline]
- Hochman JS, Sleeper LA, White HD, et al. SHOCK Investigators One-year survival following early revascularization for cardiogenic shock JAMA 2001;285:190-192.[Abstract/Free Full Text]
- Hochman JS, Sleeper LA, Webb JG, et al. SHOCK Investigators Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction JAMA 2006;295:2511-2515.[Abstract/Free Full Text]
- Brodie BR, Stuckey TD, Muncy DB, et al. Importance of time-to-reperfusion in patients with acute myocardial infarction with and without cardiogenic shock treated with primary percutaneous coronary intervention Am Heart J 2003;145:708-715.[CrossRef][Web of Science][Medline]
- Boersma E, Harrington RA, Moliterno DJ, et al. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomized clinical trials Lancet 2002;359:189-198.[CrossRef][Web of Science][Medline]
- Chan AW, Chew DP, Bhatt DL, Moliterno DJ, Topol EJ, Ellis SG. Long-term mortality benefit with the combination of stents and abciximab for cardiogenic shock complicating acute myocardial infarction Am J Cardiol 2002;89:132-136.[CrossRef][Web of Science][Medline]
Related Article
-
Contemporary Management of Cardiogenic Shock: Age Is Opportunity
- Judith S. Hochman and Adam H. Skolnick
J. Am. Coll. Cardiol. Intv. 2009 2: 153-155.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
J. S. Hochman and A. H. Skolnick
Contemporary Management of Cardiogenic Shock: Age Is Opportunity
J. Am. Coll. Cardiol. Intv.,
February 1, 2009;
2(2):
153 - 155.
[Full Text]
[PDF]
|
|
|
|
Top
Abstract
Methods