Outcomes of percutaneous coronary intervention among elderly patients in cardiogenic shock: a multicenter, decade-long experience.

OBJECTIVES

The objective of this study was to determine the characteristics and hospital mortality rate for elderly patients in cardiogenic shock undergoing emergent percutaneous coronary intervention (PCI).

BACKGROUND

Early revascularization for patients with acute myocardial infarction complicated by cardiogenic shock is recommended for patients < 75 years of age. This age-restricted recommendation is based upon evidence that elderly shock patients undergoing early revascularization have extremely high hospital mortality rates. The real world mortality rate for elderly shock patients undergoing emergent PCI has not been determined.

METHODS

We examined a decade-long experience in our prospective registry of consecutive PCIs in Northern New England to assess the generalizability of these findings. Characteristics and hospital mortality were compared for elderly ( 75 years old) versus non-elderly (< 75 years old) patients. Predictors of hospital survival were identified using multivariate logistic regression.

RESULTS

From 1990 to 2000, a total of 310 out of 52,418 patients (0.59%) had PCI for cardiogenic shock, twenty-four percent of whom were elderly. Procedural characteristics were similar between the 2 groups. Independent predictors of mortality for both groups were older age and the absence of collaterals; during the stent era (1997 2000), significant predictors were lack of stent placement and diabetes mellitus. The mortality rate for elderly shock patients undergoing PCI was 46%, which is significantly less than previously reported in randomized clinical trials.

CONCLUSION

Real world selection of elderly shock patients for PCI is possible with mortality rates far less than seen in randomized trials.