Author + information
- Received January 29, 2019
- Revision received March 12, 2019
- Accepted April 9, 2019
- Published online September 16, 2019.
- Uwe Zeymer, MDa,b,∗ (, )
- Mathias Hochadel, PhDb,
- Ann-Kathrin Karcher, MDa,
- Holger Thiele, MDc,
- Harald Darius, MDd,
- Steffen Behrens, MDe,
- Burghard Schumacher, MDf,
- Hüseyn Ince, MDg,
- Hans-Martin Hoffmeister, MDh,
- Nicolas Werner, MDa,
- Ralf Zahn, MDa,
- for the ALKK Study Group
- aKlinikum Ludwigshafen, Ludwigshafen, Germany
- bInstitut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
- cHerzzentrum Leipzig, Universitätsklinik, Leipzig, Germany
- dVivantes-Klinikum Neukölln, Berlin, Germany
- eHumboldklinikum Berlin, Berlin, Germany
- fWestpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
- gVivantes-Klinikum am Urban, Berlin, Germany
- hKlinikum Solingen, Solingen, Germany
- ↵∗Address for correspondence:
Prof. Dr. Uwe Zeymer, Klinikum Ludwigshafen, Medizinische Klinik B and Institut für Herzinfarktforschung, Bremserstrasse 79, 67063 Ludwigshafen, Germany.
Objectives The aim of this study was to determine the impact of age on procedural and clinical outcomes in patients with cardiogenic shock (CS).
Background The use of early revascularization therapy with percutaneous coronary intervention (PCI) has been shown to improve outcome in patients with acute myocardial infarction (AMI) complicated by CS.
Methods Data from consecutive patients with AMI and CS treated with PCI enrolled into the prospective ALKK (Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte) PCI registry were centrally collected and analyzed. Patients were divided into 4 groups according to their age (<65, 65 to 74, 75 to 84, and >85 years). Patients’ characteristics, procedural features, antithrombotic therapies, and in-hospital complications were compared among the 4 groups.
Results Between 2010 and 2015, a total of 2,323 consecutive patients with AMI and CS were treated by PCI in 51 hospitals. TIMI (Thrombolysis In Myocardial Infarction) flow grade 3 patency after PCI decreased with increasing age from 84% to 78%, while in-hospital mortality increased from 32% to 56%. Bleeding rates were low (2.0% to 2.3%) and not different among age groups. In the multivariate analysis, higher age, TIMI flow grade <3 after PCI, 3-vessel disease, and left main PCI were independent predictors of mortality.
Conclusions PCI in patients with AMI and CS is associated with a high procedural success rate and a low bleeding rate, even in very elderly patients, while mortality increases with increasing age. Because mortality in elderly patients with CS without revascularization therapy is very high, it seems justified to perform PCI in selected patients to reduce mortality.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 29, 2019.
- Revision received March 12, 2019.
- Accepted April 9, 2019.
- 2019 American College of Cardiology Foundation
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