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

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute myocardial infarction complicated by cardiogenic shock (n=865). Intervention: Early revascularization (<18 hours since onset of shock) vs. Later or no revascularization procedure. Primary outcome: In-hospital mortality (≥75 years group) (RR 0.46, 95% CI 0.28-0.75, p=0.002).

Key Result

Early revascularization in elderly patients (≥75 years) with AMI complicated by cardiogenic shock was associated with lower mortality compared to late or no revascularization (adjusted RR 0.46; 95% CI 0.28-0.75; P=0.002).

Study Design

Type

Observational (n=865)

PICO

Population

Acute myocardial infarction complicated by cardiogenic shock (n=865)

Intervention / Comparator

Early revascularization (<18 hours since onset of shock) vs Later or no revascularization procedure

Primary Outcome

In-hospital mortality (≥75 years group) — RR 0.46 (0.28-0.75), p=0.002

Main Result

Effect estimate: RR 0.46 (95% CI 0.28-0.75)

Absolute Event Rate: 48% vs 81%

p-value: p=0.002

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=277), and 30-day mortality of patients treated with early revascularization /=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. 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.

Read Full Paperexternally

Mark Helpful

Bookmark

Relay

View Full Paper

Mark Helpful

Bookmark

Relay

View Full Paper

Cite This Study

Vladimír Džavík (Thu,) conducted a observational in Acute myocardial infarction complicated by cardiogenic shock (n=865). Early revascularization (<18 hours since onset of shock) vs. Later or no revascularization procedure was evaluated on In-hospital mortality (≥75 years group) (RR 0.46, 95% CI 0.28-0.75, p=0.002). Early revascularization in elderly patients (≥75 years) with AMI complicated by cardiogenic shock was associated with lower mortality compared to late or no revascularization (adjusted RR 0.46; 95% CI 0.28-0.75; P=0.002).

synapsesocial.com/papers/6a12cd7792637892a9a74802 https://doi.org/https://doi.org/10.1016/s0195-668x(02)00844-8

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: