Cardiogenic shock (CS) continues to be the most important factor affecting the mortality
rate of patients with acute myocardial infarctions (AMIs). However, controversy regarding
the optimal treatment of older patients with AMIs complicated by CS still exists.
The aim of this study was to compare the results of invasive (coronary angiography
during index hospitalization) and noninvasive treatment strategies in patients aged
≥75 years with AMIs complicated by CS, defined as systolic blood pressure <90 mm Hg
or need for hemodynamic support and end-organ hypoperfusion. A multicenter Polish
registry that included data on patients with acute coronary syndromes was examined
to identify patients with AMIs treated from October 2003 to May 2007. A total of 97,531
patients with AMIs were hospitalized, and 5.5% of those patients (n = 5,390) had CS
on admission, including 1,976 patients aged ≥75 years (509 treated invasively and
1,467 treated noninvasively). In-hospital mortality was 55.4% in patients treated
invasively and 69.9% in patients treated noninvasively (p <0.0001). After 6 months,
the mortality rate was 65.8% in the invasive group and 80.5% in the noninvasive group
(p <0.0001). Propensity score analysis, in which 499 patients of each group were analyzed
after being matched for demographic and clinical data, confirmed the early and long-term
benefits of the invasive strategy. In conclusion, applying the invasive strategy to
patients with AMIs complicated by CS reduced in-hospital and 6-month mortality in
patients aged ≥75 years.
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Article Info
Publication History
Accepted:
August 11,
2010
Received in revised form:
August 11,
2010
Received:
May 16,
2010
Footnotes
This report is the result of an unfunded analysis of the Polish Registry of Acute Coronary Syndromes (PL-ACS) database. The PL-ACS registry is supported by an unrestricted grant from the Ministry of Health of Poland (Warsaw, Poland).
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
