Revascularization improves mortality in elderly patients with acute myocardial infarction complicated by cardiogenic shock

Abstract

Cardiogenic shock (AMI-CS) occurs in 2.5–6% of hospitalized patients with acute myocardial infarction (AMI), and is associated with high morbidity and mortality [ 1 Hochman J.S. Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation. 2003; 107: 2998-3002 Crossref PubMed Scopus (451) Google Scholar , 2 Holmes Jr., D.R. Berger P.B. Hochman J.S. et al. Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation. Circulation. 1999; 100: 2067-2073 Crossref PubMed Scopus (187) Google Scholar , 3 Goldberg R.J. Spencer F.A. Gore J.M. Lessard D. Yarzebski J. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009; 119: 1211-1219 Crossref PubMed Scopus (485) Google Scholar , 4 Goldberg R.J. Gore J.M. Thompson C.A. Gurwitz J.H. Recent magnitude of and temporal trends (1994–1997) in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction: the second national registry of myocardial infarction. Am Heart J. 2001; 141: 65-72 Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar ]. In the aftermath of the SHOCK trial [ [5] Hochman J.S. Sleeper L.A. Webb J.G. et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999; 341: 625-634 Crossref PubMed Scopus (2176) Google Scholar ], small observational studies reported on outcomes of elderly (≥75-year old) patients with AMI-CS (Supplement). Uncertainty however still exists regarding the benefits of early revascularization (ER) in elderly patients with AMI-CS. In the current report, we undertook aggregate data meta-analyses of short- and intermediate-term mortality outcomes to examine the impact of an ER strategy versus an initial medical stabilization (IMS) strategy in elderly patients with AMI-CS.