Abstract 15166: Early Revascularization Improves Mortality in Elderly Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock
Background: Compared to a strategy of initial medical stabilization (IMS), early revascularization (ERV) improves mortality in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Its benefits in elderly patients remain less certain.
Methods: We performed aggregate data meta-analyses of short (in-hospital/30-day) and medium-term (6-12 mo) mortality from published studies comparing ERV vs. IMS in elderly (≥ 75 yo) patients presenting with AMI complicated by CS. A Medline search from 1/1/1985 through 1/31/2011 yielded 14 comparative reports, of which 12 studies reported short-term (N= 3,113 patients) and 5 studies reported medium-term (N= 2,180 patients) mortality. A parallel search yielded 22 studies comparing mortality in elderly vs. young patients with CS undergoing ERV. Summary odds ratios and their 95% confidence intervals were computed using the random-effects model.
Results: Elderly patients undergoing ERV were more likely to be men, smokers and to have prior revascularization. Among elderly patients presenting with AMI complicated by CS, ERV was associated with reduced short-term (OR 0.48, 95% CI 0.33-0.69, Figure) and medium-term (OR 0.47, 95% CI 0.27-0.83) mortality compared with an IMS strategy. Sensitivity analyses demonstrated the short-term survival benefit of ERV was independent of the influence of any single study. Compared with young patients, elderly patients who received ERV experienced a higher short- (N= 5,846 patients; OR 2.38, 95% CI 1.92-2.96) and medium-term (N= 1,026 patients; OR 2.80, 95% CI 1.97-3.99) mortality.
Conclusion: Although elderly patients presenting with AMI complicated by CS represent a high-risk population, a strategy of ERV still reduces mortality in appropriately-selected elderly patients compared with an IMS strategy. Our findings do not support age-specific recommendations regarding initial therapeutic strategies (ERV vs. IMS) for patients with AMI complicated by CS.
- © 2011 by American Heart Association, Inc.