Percutaneous coronary intervention for ST-elevation myocardial infarction complicated by cardiogenic shock in a super-aging society

Author:

Nishihira Kensaku1ORCID,Honda Satoshi2,Takegami Misa34,Kojima Sunao5ORCID,Takahashi Jun6,Itoh Tomonori7,Watanabe Tetsu8,Yamashita Jun9,Saji Mike10ORCID,Tsujita Kenichi11ORCID,Takayama Morimasa10,Sumiyoshi Tetsuya10,Kimura Kazuo12,Yasuda Satoshi6ORCID

Affiliation:

1. Department of Cardiology, Miyazaki Medical Association Hospital , 1173 Arita, Miyazaki 880-2102 , Japan

2. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center , Suita , Japan

3. Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center , Suita , Japan

4. Department of Public Health and Health Policy, Graduate School of Medicine, The University of Tokyo , Tokyo , Japan

5. Department of Cardiology, Sakura-jyuji Yatsushiro Rehabilitation Hospital , Kumamoto , Japan

6. Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine , Sendai , Japan

7. Division of Community Medicine, Department of Medical Education/Division of Cardiology, Department of Medicine, Iwate Medical University , Morioka , Japan

8. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine , Yamagata , Japan

9. Department of Cardiology, Tokyo Medical University Hospital , Tokyo , Japan

10. Department of Cardiology, Sakakibara Heart Institute , Fuchu , Japan

11. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan

12. Division of Cardiology, Yokohama City University Medical Center , Yokohama , Japan

Abstract

Abstract Aims ST-segment elevation myocardial infarction complicated by cardiogenic shock (STEMICS) is associated with substantial mortality. As life expectancy increases, percutaneous coronary intervention (PCI) is being performed more frequently, even in elderly patients with acute myocardial infarction (AMI). This study sought to investigate the characteristics and impact of PCI on in-hospital mortality in patients with STEMICS. Methods and results The Japan AMI Registry (JAMIR) is a retrospective, nationwide, real-world database. Among 46 242 patients with AMI hospitalized in 2011–2016, 2760 patients with STEMICS (median age, 72 years) were studied. We compared 2396 (86.8%) patients who underwent PCI with 364 (13.2%) patients who did not. The percentage of mechanical circulatory support use in patients with STEMICS was 69.3% and in-hospital mortality was 34.6%. Compared with patients who did not undergo PCI, patients undergoing PCI were younger and had a higher rate of intra-aortic balloon pump use. A higher proportion was male or current smokers. In-hospital mortality was significantly lower in the PCI group than in the no-PCI group (31.3% vs. 56.0%, P < 0.001). Percutaneous coronary intervention was independently associated with lower in-hospital mortality [adjusted odds ratio (OR), 0.508; 95% confidence interval (CI), 0.347–0.744]. In 789 (28.6%) patients aged ≥80 years, PCI was associated with fewer in-hospital cardiac deaths (adjusted OR, 0.524; 95% CI, 0.281–0.975), but was not associated with in-hospital mortality (adjusted OR, 0.564; 95% CI, 0.300–1.050). Conclusion In Japan, PCI was effective in reducing in-hospital cardiac death in elderly patients with STEMICS. Age alone should not preclude potentially beneficial invasive therapy.

Funder

Grant-in-Aid for Scientific Research

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Critical Care and Intensive Care Medicine,General Medicine

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