Early percutaneous intervention improves survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock.

BACKGROUND: The safety and effectiveness of emergency percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) are currently unknown.

AIM: To compare the outcome of elderly patients with AMI complicated by CS who were treated with primary PCI or thrombolysis.

METHODS: Between 2001 and 2006 at Xijing Hospital we evaluated the outcome of 94 patients ł75 years old with AMI complicated by CS, of whom 33 underwent emergency PCI (PCI group), whereas the other 61 received initially conventional medication (CM group).

RESULTS: Baseline characteristics, infarct location, rate of intra-aortic balloon pump support and time from AMI onset to therapy were similar between the two groups. The success rate of revascularisation in the PCI group was 90.9% and the success rate of thrombolysis in the CM group was 60.7% (p=0.004). The PCI group had a lower in-hospital mortality than the CM group (42.4 vs. 65.6%, p=0.026). Kaplan-Meier curves showed a significant difference in survival (48.48 vs. 21.31%, p=0.006), favouring early PCI. Multiple logistic regression identified time from AMI onset to therapy as an independent predictor of in-hospital death (p=0.036). Cox regression analysis indicated early PCI as an independent factor to improve mid-term survival (p=0.015).

CONCLUSIONS: Emergency PCI improves 1-year survival compared with initial conventional medication for elderly patients with AMI complicated by CS.