Survival Benefit from Early Revascularization in Elderly Patients with Cardiogenic Shock after Acute Myocardial Infarction: A Cohort Study

Objectives To assess dearly revascularization offers any survival benefit in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) who are >= 75 years of age Background CS after AMI continues to pose formidable therapeutic challenges in elderly patients Methods We conducted survival analyses of 310 consecutive subjects (including 80 patients >= 75 years of age) who developed cardiogenic shock after AMI at two study centers - Rush University Medical Center and the John H Stroger Jr Hospital of Cook County (both in Chicago Illinois) The data were collected over a 6 year period Where appropriate we used Kaplan Meier survival plots multivariate Cox proportional hazards modeling stepwise multivariate Poisson regression analyses and unconditional logistic regression analysis Results Early revascularization was associated with a statistically significant survival benefit both in patients < 75 years of age (relative hazard 0 40 95% confidence interval [CI] 0 28-0 59 p < 0 001) as well as in patients >= 75 years of age (relative hazard 0 56, 95% CI 0 32-0 99, p = 0 049) This benefit remained significant even after adjusting for the simultaneous Sects of several putative confounders In patients >= 75 years of age, this survival benefit was evident very early and was sustained all through the period of follow up of the cohort Conclusions These retrospective data suggest a significant survival benefit of early revascularization in elderly patients >= 75 years of age developing CS after AMI, albeit less as compared to those aged < 75 years