Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Catheter Cardiovasc Interv. 2011 Oct 1;78(4):505-11. doi: 10.1002/ccd.22911. Epub 2011 Jan 4.
Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI), associated with a high mortality. A significant improvement in survival has been reported with immediate coronary revascularization. However, there is no clear evidence of such an improvement amongst older patients. The aim of our work was to evaluate in-hospital and long-term outcomes in the group of elderly AMI patients with CS (≥75 years old).
We collected data of 157 consecutive AMI patients with CS who underwent percutaneous coronary intervention (PCI) and compared clinical and procedural characteristics and in-hospital and long-term outcomes between patients <75 years and patients ≥75 years old.
There were 58 patients (36.9%) with age ≥75 years and 99 patients (63.1%) with age <75 years. Patients were followed up for an average period of 34 months (range 5-69). In-hospital and long-term mortality was significantly higher in the older group (55 vs. 25%, P < 0.0001; and 62.1 vs. 37.3%, P = 0.005, respectively). Multivariate predictors of in-hospital mortality were age ≥75 years (hazard ratio 1.81, 95% CI 1.006-3.27, P = 0.04) and PCI failure (hazard ratio 2.67, 95% CI 1.34-5.307, P = 0.005), whereas, the only multivariate predictor of long-term mortality was PCI failure (hazard ratio 2.88, 95% CI 1.52-5.46, P = 0.001). Age ≥75 years showed only a trend toward statistical significance (hazard ratio 1.62, 95% CI 0.96-2.76, P = 0.07).
In elderly AMI patients with CS, PCI can be performed with an acceptable risk that seems lower than that reported in most previous studies.
心原性休克（CS）是急性心肌梗死（AMI）的严重并发症，与高死亡率相关。即刻冠状动脉血运重建可显著提高生存率。然而，对于老年患者，尚无明确证据表明有此改善。我们的工作旨在评估 CS（≥75 岁）老年 AMI 患者的住院和长期结局。
我们收集了 157 例连续接受经皮冠状动脉介入治疗（PCI）的 AMI 合并 CS 患者的数据，并比较了年龄<75 岁和年龄≥75 岁患者的临床和程序特征以及住院和长期结局。
年龄≥75 岁的患者有 58 例（36.9%），年龄<75 岁的患者有 99 例（63.1%）。患者平均随访 34 个月（5-69 个月）。年龄较大组的住院和长期死亡率显著更高（55%比 25%，P<0.0001；62.1%比 37.3%，P=0.005）。住院死亡率的多变量预测因素为年龄≥75 岁（危险比 1.81，95%CI 1.006-3.27，P=0.04）和 PCI 失败（危险比 2.67，95%CI 1.34-5.307，P=0.005），而长期死亡率的唯一多变量预测因素是 PCI 失败（危险比 2.88，95%CI 1.52-5.46，P=0.001）。年龄≥75 岁仅具有统计学意义的趋势（危险比 1.62，95%CI 0.96-2.76，P=0.07）。
在 CS 老年 AMI 患者中，PCI 可在可接受的风险下进行，其风险似乎低于大多数既往研究报道的风险。
