0135: Cardiogenic shock in elderly patients with acute myocardial infarction. The FAST-MI programme

Abstract

Though cardiogenic shock (CS) after AMI is more common in the elderly, information on its prevalence, determinants and prognostic factors in the aged is scarce. We analysed incidence and 1-year mortality of CS in 4 nationwide French surveys carried out 5 years apart from 1995 to 2010, including consecutive STEMI and NSTEMI patients over one-month periods. Among the 10,610 patients, 3,389 were aged ≥75 years, of whom 9.9% developed CS. Incidence of CS decreased from 11.6% in 1995 to 6.7% in 2010, P=0.02. Use of PCI ≤3 days from admission increased for both patients with and without CS (11% to 48% and 5% to 55%, respectively), as did statin use (1% to 70% and 4% to 82%, respectively). Occurrence of atrial and ventricular fibrillation decreased in patients without CS (22% to 9%, and 3.6% to 1.5%, respectively, P<0.001), but not in those with CS (19% to 20%, and 10% to 8%, respectively). Conversely, AV block decreased in patients with (30% to 11%) or without CS (9% to 3%). One-year mortality was 77% in CS patients, versus 22% in patients without CS. From 1995 to 2010, mortality decreased from 87% to 59% in CS patients and from 30% to 17% in patients without CS (P<0.001). In CS patients, age, ventricular fibrillation and STEMI, were independent correlates of increased 1-year death, while study period was associated with decreased mortality (2010 vs 1995: HR 0.56,0.33-0.94 P=0.03), along with early use of PCI, statins or LMWH. The prevalence of CS is higher in elderly patients but has decreased in the past 15 years. One-year mortality remains considerable, but decreased by 32%, a decrease potentially mediated by broader use of PCI, statins and LMWH. Occurrence of ventricular fibrillation in patients with CS is a correlate of increased one-year mortality. Abstract 0135 – Figure