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

V. Dzavik, L. A. Sleeper, T. P. Cocke, M. Moscucci, J. Saucedo, S. Hosat, X. Jiang, J. Slater, T. LeJemtel, J. S. Hochman

Research output: Contribution to journalArticle

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Abstract

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, therelative 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.

Original languageEnglish
Pages (from-to)828-837
Number of pages10
JournalEuropean Heart Journal
Volume24
Issue number9
DOIs
StatePublished - May 1 2003

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Cardiogenic Shock
Registries
Myocardial Infarction
Survival
Shock
Risk Adjustment
Mortality
Hospital Mortality
Renal Insufficiency
Comorbidity
Anatomy
Heart Failure
Age Groups
Confidence Intervals

Keywords

  • Age
  • Cardiogenic shock
  • Elderly
  • Prognosis
  • Revascularization
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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. / Dzavik, V.; Sleeper, L. A.; Cocke, T. P.; Moscucci, M.; Saucedo, J.; Hosat, S.; Jiang, X.; Slater, J.; LeJemtel, T.; Hochman, J. S.

In: European Heart Journal, Vol. 24, No. 9, 01.05.2003, p. 828-837.

Research output: Contribution to journalArticle

Dzavik, V. ; Sleeper, L. A. ; Cocke, T. P. ; Moscucci, M. ; Saucedo, J. ; Hosat, S. ; Jiang, X. ; Slater, J. ; LeJemtel, T. ; Hochman, J. S. / 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. In: European Heart Journal. 2003 ; Vol. 24, No. 9. pp. 828-837.
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abstract = "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, therelative 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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T1 - Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock

T2 - A report from the SHOCK Trial Registry

AU - Dzavik, V.

AU - Sleeper, L. A.

AU - Cocke, T. P.

AU - Moscucci, M.

AU - Saucedo, J.

AU - Hosat, S.

AU - Jiang, X.

AU - Slater, J.

AU - LeJemtel, T.

AU - Hochman, J. S.

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Y1 - 2003/5/1

N2 - 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, therelative 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.

AB - 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, therelative 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.

KW - Age

KW - Cardiogenic shock

KW - Elderly

KW - Prognosis

KW - Revascularization

KW - Survival

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