0135: Cardiogenic shock in elderly patients with acute myocardial infarction. The FAST-MI programme

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• 作者：Nadia Aissaoui ; ⁽¹⁾ ; ^{nadia.aissaoui13@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Etienne Puymirat⁽¹⁾ ; Yves Juilliè ; re⁽²⁾ ; S. Cattan⁽³⁾ ; F. Schiele⁽⁴⁾ ; J. Ferrieres⁽⁵⁾ ; Simon Tabassome⁽⁶⁾ ; Nicolas Danchin⁽⁶⁾
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：8
• 期：1
• 页码：111
• 全文大小：51 K

文摘

Though cardiogenic shock (CS) after AMI is more common in the elderly, information on its prevalence, determinants and prognostic factors in the aged is scarce.

Methods

We analysed incidence and 1-year mortality of CS in 4 nationwide French surveys carried out 5 years apart from 1995 to 2010, including consecutive STEMI and NSTEMI patients over one-month periods.

Results

Among the 10,610 patients, 3,389 were aged ≥75 years, of whom 9.9% developed CS.

Incidence of CS decreased from 11.6% in 1995 to 6.7% in 2010, P=0.02. Use of PCI ≤3 days from admission increased for both patients with and without CS (11% to 48% and 5% to 55%, respectively), as did statin use (1% to 70% and 4% to 82%, respectively). Occurrence of atrial and ventricular fibrillation decreased in patients without CS (22% to 9%, and 3.6% to 1.5%, respectively, P<0.001), but not in those with CS (19% to 20%, and 10% to 8%, respectively).

Conversely, AV block decreased in patients with (30% to 11%) or without CS (9% to 3%).

One-year mortality was 77% in CS patients, versus 22% in patients without CS. From 1995 to 2010, mortality decreased from 87% to 59% in CS patients and from 30% to 17% in patients without CS (P<0.001). In CS patients, age, ventricular fibrillation and STEMI, were independent correlates of increased 1-year death, while study period was associated with decreased mortality (2010 vs 1995: HR 0.56,0.33-0.94 P=0.03), along with early use of PCI, statins or LMWH.

Conclusion

The prevalence of CS is higher in elderly patients but has decreased in the past 15 years. One-year mortality remains considerable, but decreased by 32%, a decrease potentially mediated by broader use of PCI, statins and LMWH. Occurrence of ventricular fibrillation in patients with CS is a correlate of increased one-year mortality.