Survival benefit from early revascularization in elderly patients with cardiogenic shock after acute myocardial infarction: A cohort study

OBJECTIVES: To assess if early revascularization offers any survival benefit in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) who are ≥ 75 years of age. BACKGROUND: CS after AMI continues to pose formidable therapeutic challenges in elderly patients. METHODS: We conducted survival analyses of 310 consecutive subjects (including 80 patients ≥ 75 years of age) who developed cardiogenic shock after AMI at two study centers - Rush University Medical Center and the John H. Stroger Jr. Hospital of Cook County (both in Chicago, Illinois). The data were collected over a 6-year period. Where appropriate, we used Kaplan-Meier survival plots, multivariate Cox proportional hazards modeling, stepwise multivariate Poisson regression analyses and unconditional logistic regression analysis. RESULTS: Early revascularization was associated with a statistically significant survival benefit both in patients < 75 years of age (relative hazard 0.40, 95% confidence interval [CI] 0.28-0.59; p < 0.001), as well as in patients ≥ 75 years of age (relative hazard 0.56, 95% CI 0.32-0.99; p ≤ 0.049). This benefit remained significant even after adjusting for the simultaneous effects of several putative confounders. In patients ≥ 75 years of age, this survival benefit was evident very early and was sustained all through the period of follow up of the cohort. CONCLUSIONS: These retrospective data suggest a significant survival benefit of early revascularization in elderly patients ≥ 75 years of age developing CS after AMI, albeit less as compared to those aged < 75 years.