Outcomes and early revascularization for patients >= 65 years of age with cardiogenic shock

Hospital survival of patients with acute myocardial infarction (AMI) compli cated by cardiogenic shock has improved during recent years. It is unclear whether this mortality benefit also applies to elderly patients with cardio genic shock. Elderly residents (age greater than or equal to 65 years) of t he Worcester, Massachusetts metropolitan area (1990 census population = 437 ,000) hospitalized with confirmed AMI and cardiogenic shock in all metropol itan Worcester, Massachusetts hospitals between 1986 and 1997 constituted t he sample of interest. We examined the use of coronary reperfusion strategi es, adjunctive therapy, and hospital mortality in a cohort of 166 cardiogen ic patients treated early in the reperfusion era (1986 to 1991) compared wi th 144 patients with AMI treated approximately 1 decade later (1993 to 1997 ). There was a significant increase in the use of an early revascularizatio n strategy over time (2% vs 16%, p <0.001). Marked increases in use of anti platelet therapy, p blockers, and angiotensin-converting enzyme inhibitors were also observed over the decade-long experience. In-hospital case fatali ty declined significantly over time, from 80% (1986 to 1991) to 69% (1993 t o 1997) in elderly patients who developed cardiogenic shock (p = 0.03), Aft er adjusting for differences in potentially confounding prognostic characte ristics between patients hospitalized in the 2 study periods, on even more pronounced reduction in hospital mortality (42%) was observed for the most recently hospitalized cohort. The most powerful predictor of in-hospital su rvival was use of an early revascularization approach to treatment. Thus, h ospital mortality has declined for patients <greater than or equal to>65 ye ars of age with AMI complicated by cardiogenic shock, and this decline has occurred in the setting of broader use of early revascularization and adjun ctive medical therapy for this high-risk population. (C) 2001 by Excerpta M edica, Inc.