Impact of Age in Acute Myocardial Infarction Cardiogenic Shock. Insights from the National Cardiogenic Shock Initiative
Lemor A, Basir MB, Gorgis S, Todd J, Marso S, Gelormini J, Akhtar Y, Baker J, Chahin J, Abdul-Waheed M, Thukral N, and O'Neill W. Impact of Age in Acute Myocardial Infarction Cardiogenic Shock. Insights from the National Cardiogenic Shock Initiative. Crit Pathw Cardiol 2021.
Crit Pathw Cardiol
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. 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 years old. We included 300 patients; 238 were (79.3%) and 62 patients ≥75 years old. There were significant differences in survival; patients 75.6% survival, while those ≥75 years old had a 50% survival (aOR:10.4, p=0.001). SCAI shock classification impacted survival as well; those 84%, compared to 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 (76.7% with 1 and 60.5% with >1 vasopressor). In conclusion, age is inversely proportional with survival; patients RHC, 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.
ePub ahead of print