The elderly represent a growing proportion of patients presenting with acute myocardial infarction (MI) complicated by cardiogenic shock (CS).
CS occurs when the heart fails to supply enough blood to the organs of the body, and remains the most common cause of death after heart attack among people 75 years of age and older. Proper selection of older patients for invasive management of heart disease remains a serious medical challenge, especially as the elderly are frequently underrepresented in or excluded from clinical trials.
In a study published in the February 2009 issue of JACC: Cardiovascular Interventions , researchers found the one-year survival of elderly patients (age ¡Ý 75 years) with acute MI complicated by CS undergoing percutaneous coronary intervention (PCI) using contemporary techniques was comparable with survival of younger patients.
"Elderly patients who are admitted to the hospital with massive heart attacks may still benefit from emergency coronary artery balloon angioplasty and stenting, despite their advanced age," says David Clark, M.B.B.S., F.R.A.C.P., senior author of the study and interventional cardiologist at Austin Hospital, Melbourne, Australia. "Although mortality occurs in roughly half of patients in these high risk situations, without this aggressive treatment, the prospect of survival is very poor."
Researchers analyzed baseline characteristics (e.g., smoking status, blood pressure, previous MI, renal function and symptom onset) and clinical outcomes, including death and emergence of other complications, in 143 consecutive patients from the Melbourne Interventional Group registry between 2004 and 2007. Elderly patients (n=45) were more likely to be female and have hypertension, previous MI, renal failure and multi-vessel coronary artery disease. Data indicated no significant differences for in-hospital, 30-day and one-year mortality in the elderly versus the younger groups.