| Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock: a report from the SHOCK Trial Registry. | |
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MedLine Citation:
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PMID: 12727150 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: The SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK (SHOCK) Trial showed no benefit of early revascularization in patients aged >/=75 years with acute myocardial infarction and cardiogenic shock. We examined the effect of age on treatment and outcomes of patients with cardiogenic shock in the SHOCK Trial Registry. METHODS AND RESULTS: We compared clinical and treatment factors in patients in the SHOCK Trial Registry with shock due to pump failure aged <75 years (n=588) and >/=75 years (n=277), and 30-day mortality of patients treated with early revascularization <18 hours since onset of shock and those undergoing a later or no revascularization procedure. After excluding early deaths covariate-adjusted relative risk and 95% confidence intervals were calculated to compare the revascularization strategies within the two age groups. Older patients more often had prior myocardial infarction, congestive heart failure, renal insufficiency, other comorbidities, and severe coronary anatomy. In-hospital mortality in the early vs. late or no revascularization groups was 45 vs. 61% for patients aged <75 years (p=0.002) and 48 vs. 81% for those aged >/=75 years (p=0.0003). After exclusion of 65 early deaths and covariate adjustment, the relative risk was 0.76 (0.59, 0.99; p=0.045) in patients aged <75 years and 0.46 (0.28, 0.75; p=0.002) in patients aged >/=75 years. CONCLUSIONS: Elderly patients with myocardial infarction complicated by cardiogenic shock are less likely to be treated with invasive therapies than younger patients with shock. Covariate-adjusted modeling reveals that elderly patients selected for early revascularization have a lower mortality rate than those receiving a revascularization procedure later or never. |
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Authors:
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V Dzavik; L A Sleeper; T P Cocke; M Moscucci; J Saucedo; S Hosat; X Jiang; J Slater; T LeJemtel; J S Hochman; |
Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: European heart journal Volume: 24 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 2003 May |
Date Detail:
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Created Date: 2003-05-02 Completed Date: 2003-06-26 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 828-37 Citation Subset: IM |
Affiliation:
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University of Toronto, Toronto, Ontario, Canada. vlad.dzavik@uhn.on.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Data Collection Female Humans Male Myocardial Infarction / complications, mortality, therapy* Myocardial Revascularization / methods*, mortality Prospective Studies Registries Shock, Cardiogenic / complications*, mortality Survival Analysis |
| Grant Support | |
ID/Acronym/Agency:
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HL49970/HL/NHLBI NIH HHS; R01 HL50020/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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