TY - JOUR
T1 - Survival benefit from early revascularization in elderly patients with cardiogenic shock after acute myocardial infarction
T2 - A cohort study
AU - Amin, Amit P.
AU - Nathan, Sandeep
AU - Prodduturi, Prathima
AU - D'Silva, Oliver
AU - Gupta, Akshay
AU - Kumar, Arun
AU - Senter, Shaun
AU - Mamtani, Manju
AU - Kulkarni, Hemant
AU - Klein, Lloyd W.
AU - Kelly, Russell F.
PY - 2009/7
Y1 - 2009/7
N2 - 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.
AB - 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.
KW - Cardiogenic shock
KW - Early invasive therapy
KW - Elderly
KW - Primary percutaneous coronary intervention
KW - Revascularization
KW - ST-segment elevation myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=68049085673&partnerID=8YFLogxK
M3 - Article
C2 - 19571337
AN - SCOPUS:68049085673
VL - 21
SP - 305
EP - 312
JO - Journal of Invasive Cardiology
JF - Journal of Invasive Cardiology
SN - 1042-3931
IS - 7
ER -