Shortage of influential factors in the evolution of ischemic cardiogenic shock.

• Main Authors: Víctor M. Hidalgo Olivares, José A. Rodríguez Montes, Pedro J. Tárraga López
• Format: Article
• Language: English
• Published: Asociación Para el Progreso de la Biomedicina 2017-04-01
• Series: Jounal of Negative and No Positive Results
• Subjects: Acute Myocardial Infarction; Age; ; Survival; Revascularization
• Online Access: http://www.jonnpr.com/pdf/1306.pdf

Objective: To evaluate the influence of age on long-term prognosis of patients with ischemic cardiogenic shock who were treated with early coronary revascularization. Methods: Prospective observational study of patients that were admitted to the Coronary Care Unit between 1 January 2006 and 1 January 2011 with diagnosis of ischemic cardiogenic shock who were treated by coronary revascularization in the first 72 hours. There was a follow up of the patients during hospitalization and after discharge, completing a follow-up of 5 years. Results: 97 patients diagnosed with ischemic cardiogenic shock were admitted , of whom 44 were patients aged 75 years or older. Males in group of patients ≥ 75 years was 56 %, significantly lower vs males in group of patients < 75 years (81 %, p: 0.009). No significant differences were found between both groups with regard to the history of hypertension, dyslipidemia, atherosclerotic disease or associated pathologies (chronic obstructive pulmonary disease, ACV or chronic renal failure). There were a greater number of diabetic patients (20.4 % vs 49 %, p: 0.004) and fewer smokers (4.5 % vs 39.6 %, p: 0.001) in group of patients ≥ 75 years. No differences were found in type or location of myocardial infarction, being similar incidence of left main coronary artery disease or multivessel disease. Percutaneous coronary revascularization was performed in all patients. No differences were found in TIMI pre- and post- revascularization or multivessel revascularization (20.4 % of patients ≥ 75 years vs 15 % of younger patients, p = 0.3). Use of glycoprotein IIb/IIIa inhibitors and intra-aortic balloon pump were similar between two groups. There was no difference in mortality during hospitalization according to the sex of patients, but there was a clear influence in prognosis of LVEF. The patients who died during follow-up, 73.8 % had a LVEF <35 %, p 0.02). Performing an analysis of survival by age groups stratified by LVEF, again it shows that regardless of LVEF, patients aged ≥ 75 years have lower survival compared to younger patients. Conclusions: Only age ≥ 75 years , LVEF <35 % and previous atherosclerotic disease were independent variables associated with mortality during follow-up