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Comparison of Invasive and Non-Invasive Treatment Strategies in Older Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the Polish Registry of Acute Coronary Syndromes - PL-ACS)
Cardiogenic shock (CS) continues to be the most important factor affecting the mortality rate of patients with acute myocardial infarctions (AMIs). However, controversy regarding the optimal treatment of older patients with AMIs complicated by CS still exists. The aim of this study was to compare th...
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Published in: | The American journal of cardiology 2011, Vol.107 (1), p.30-36 |
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creator | Gasior, Mariusz, MD, PhD Slonka, Grzegorz, MD Wilczek, Krzysztof, MD Gierlotka, Marek, MD Ruzyllo, Witold, MD, PhD Zembala, Marian, MD, PhD Osadnik, Tadeusz, MD Dubiel, Jacek, MD, PhD Zdrojewski, Tomasz, MD, PhD Kalarus, Zbigniew, MD, PhD Polonski, Lech, MD, PhD |
description | Cardiogenic shock (CS) continues to be the most important factor affecting the mortality rate of patients with acute myocardial infarctions (AMIs). However, controversy regarding the optimal treatment of older patients with AMIs complicated by CS still exists. The aim of this study was to compare the results of invasive (coronary angiography during index hospitalization) and noninvasive treatment strategies in patients aged ≥75 years with AMIs complicated by CS, defined as systolic blood pressure |
doi_str_mv | 10.1016/j.amjcard.2010.08.039 |
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However, controversy regarding the optimal treatment of older patients with AMIs complicated by CS still exists. The aim of this study was to compare the results of invasive (coronary angiography during index hospitalization) and noninvasive treatment strategies in patients aged ≥75 years with AMIs complicated by CS, defined as systolic blood pressure <90 mm Hg or need for hemodynamic support and end-organ hypoperfusion. A multicenter Polish registry that included data on patients with acute coronary syndromes was examined to identify patients with AMIs treated from October 2003 to May 2007. A total of 97,531 patients with AMIs were hospitalized, and 5.5% of those patients (n = 5,390) had CS on admission, including 1,976 patients aged ≥75 years (509 treated invasively and 1,467 treated noninvasively). In-hospital mortality was 55.4% in patients treated invasively and 69.9% in patients treated noninvasively (p <0.0001). After 6 months, the mortality rate was 65.8% in the invasive group and 80.5% in the noninvasive group (p <0.0001). Propensity score analysis, in which 499 patients of each group were analyzed after being matched for demographic and clinical data, confirmed the early and long-term benefits of the invasive strategy. In conclusion, applying the invasive strategy to patients with AMIs complicated by CS reduced in-hospital and 6-month mortality in patients aged ≥75 years.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2010.08.039</identifier><identifier>PMID: 21146682</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Angioplasty, Balloon, Coronary ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Clinical medicine ; Comparative analysis ; Coronary Angiography ; Coronary heart disease ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Female ; Follow-Up Studies ; Heart ; Heart attacks ; Humans ; Intensive care medicine ; Male ; Medical sciences ; Myocardial Infarction - complications ; Myocardial Infarction - mortality ; Myocardial Infarction - therapy ; Myocarditis. Cardiomyopathies ; Older people ; Patients ; Poland ; Registries ; Shock, Cardiogenic - etiology ; Treatment Outcome</subject><ispartof>The American journal of cardiology, 2011, Vol.107 (1), p.30-36</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Sequoia S.A. Jan 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c476t-a70abdc02aae9fedea6a172072fe64e7c61d3adee33b1fbd789fe99eea5ed6f23</citedby><cites>FETCH-LOGICAL-c476t-a70abdc02aae9fedea6a172072fe64e7c61d3adee33b1fbd789fe99eea5ed6f23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4021,27921,27922,27923</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23960464$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21146682$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gasior, Mariusz, MD, PhD</creatorcontrib><creatorcontrib>Slonka, Grzegorz, MD</creatorcontrib><creatorcontrib>Wilczek, Krzysztof, MD</creatorcontrib><creatorcontrib>Gierlotka, Marek, MD</creatorcontrib><creatorcontrib>Ruzyllo, Witold, MD, PhD</creatorcontrib><creatorcontrib>Zembala, Marian, MD, PhD</creatorcontrib><creatorcontrib>Osadnik, Tadeusz, MD</creatorcontrib><creatorcontrib>Dubiel, Jacek, MD, PhD</creatorcontrib><creatorcontrib>Zdrojewski, Tomasz, MD, PhD</creatorcontrib><creatorcontrib>Kalarus, Zbigniew, MD, PhD</creatorcontrib><creatorcontrib>Polonski, Lech, MD, PhD</creatorcontrib><title>Comparison of Invasive and Non-Invasive Treatment Strategies in Older Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the Polish Registry of Acute Coronary Syndromes - PL-ACS)</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Cardiogenic shock (CS) continues to be the most important factor affecting the mortality rate of patients with acute myocardial infarctions (AMIs). However, controversy regarding the optimal treatment of older patients with AMIs complicated by CS still exists. The aim of this study was to compare the results of invasive (coronary angiography during index hospitalization) and noninvasive treatment strategies in patients aged ≥75 years with AMIs complicated by CS, defined as systolic blood pressure <90 mm Hg or need for hemodynamic support and end-organ hypoperfusion. A multicenter Polish registry that included data on patients with acute coronary syndromes was examined to identify patients with AMIs treated from October 2003 to May 2007. A total of 97,531 patients with AMIs were hospitalized, and 5.5% of those patients (n = 5,390) had CS on admission, including 1,976 patients aged ≥75 years (509 treated invasively and 1,467 treated noninvasively). In-hospital mortality was 55.4% in patients treated invasively and 69.9% in patients treated noninvasively (p <0.0001). After 6 months, the mortality rate was 65.8% in the invasive group and 80.5% in the noninvasive group (p <0.0001). Propensity score analysis, in which 499 patients of each group were analyzed after being matched for demographic and clinical data, confirmed the early and long-term benefits of the invasive strategy. In conclusion, applying the invasive strategy to patients with AMIs complicated by CS reduced in-hospital and 6-month mortality in patients aged ≥75 years.</description><subject>Acute coronary syndromes</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Clinical medicine</subject><subject>Comparative analysis</subject><subject>Coronary Angiography</subject><subject>Coronary heart disease</subject><subject>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Older people</subject><subject>Patients</subject><subject>Poland</subject><subject>Registries</subject><subject>Shock, Cardiogenic - etiology</subject><subject>Treatment Outcome</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNqFkt2O0zAQhSMEYsvCI4AsJARcpNhOmp8bUFXxs1JhK7qIS2tqT7buJnGx3Up9Sx6JiVqKtDdcWR5_PnPsM0nyXPCx4KJ4txlDt9HgzVhyqvFqzLP6QTISVVmnohbZw2TEOZdpLfL6InkSwoa2QkyKx8mFFCIvikqOkt8z123B2-B65hp21e8h2D0y6A375vr0XLjxCLHDPrJl9BDx1mJgtmfXrUHPFhAtnQX208Y1m-pdRPb14AZ_FlqSbcDraKnJ0K-1mhQMWx3YbCDcLfZWs-Xa6Tv2pvGuY3GNbOFaG9bsO_UK0R8Gf0flmfOuB6osD70hmpykbDFPp7Pl26fJowbagM9O62Xy49PHm9mXdH79-Wo2nac6L4uYQslhZTSXAFg3aBAKEKXkpWywyLHUhTAZGMQsW4lmZcqKqLpGhAmaopHZZfL6qLv17tcOQ1SdDRrbFnp0u6Aq-uM6l2VG5Mt75MbtfE_mVCXqklMOFUGTI6S9C8Fjo7bedvRGJbgaAlcbdQpcDYErXikKnO69OInvVh2a862_CRPw6gRA0NA2Hnptwz8uqwueFzlxH44c0qftLXoVNEWq0ViPOirj7H-tvL-noFtLuUJ7hwcM50cLFaTiajlM5zCcgsaylDLP_gBAl-Sa</recordid><startdate>2011</startdate><enddate>2011</enddate><creator>Gasior, Mariusz, MD, PhD</creator><creator>Slonka, Grzegorz, MD</creator><creator>Wilczek, Krzysztof, MD</creator><creator>Gierlotka, Marek, MD</creator><creator>Ruzyllo, Witold, MD, PhD</creator><creator>Zembala, Marian, MD, PhD</creator><creator>Osadnik, Tadeusz, MD</creator><creator>Dubiel, Jacek, MD, PhD</creator><creator>Zdrojewski, Tomasz, MD, PhD</creator><creator>Kalarus, Zbigniew, MD, PhD</creator><creator>Polonski, Lech, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>2011</creationdate><title>Comparison of Invasive and Non-Invasive Treatment Strategies in Older Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the Polish Registry of Acute Coronary Syndromes - PL-ACS)</title><author>Gasior, Mariusz, MD, PhD ; Slonka, Grzegorz, MD ; Wilczek, Krzysztof, MD ; Gierlotka, Marek, MD ; Ruzyllo, Witold, MD, PhD ; Zembala, Marian, MD, PhD ; Osadnik, Tadeusz, MD ; Dubiel, Jacek, MD, PhD ; Zdrojewski, Tomasz, MD, PhD ; Kalarus, Zbigniew, MD, PhD ; Polonski, Lech, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c476t-a70abdc02aae9fedea6a172072fe64e7c61d3adee33b1fbd789fe99eea5ed6f23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Acute coronary syndromes</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Biological and medical sciences</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Clinical medicine</topic><topic>Comparative analysis</topic><topic>Coronary Angiography</topic><topic>Coronary heart disease</topic><topic>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Myocardial Infarction - complications</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocarditis. Cardiomyopathies</topic><topic>Older people</topic><topic>Patients</topic><topic>Poland</topic><topic>Registries</topic><topic>Shock, Cardiogenic - etiology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gasior, Mariusz, MD, PhD</creatorcontrib><creatorcontrib>Slonka, Grzegorz, MD</creatorcontrib><creatorcontrib>Wilczek, Krzysztof, MD</creatorcontrib><creatorcontrib>Gierlotka, Marek, MD</creatorcontrib><creatorcontrib>Ruzyllo, Witold, MD, PhD</creatorcontrib><creatorcontrib>Zembala, Marian, MD, PhD</creatorcontrib><creatorcontrib>Osadnik, Tadeusz, MD</creatorcontrib><creatorcontrib>Dubiel, Jacek, MD, PhD</creatorcontrib><creatorcontrib>Zdrojewski, Tomasz, MD, PhD</creatorcontrib><creatorcontrib>Kalarus, Zbigniew, MD, PhD</creatorcontrib><creatorcontrib>Polonski, Lech, MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gasior, Mariusz, MD, PhD</au><au>Slonka, Grzegorz, MD</au><au>Wilczek, Krzysztof, MD</au><au>Gierlotka, Marek, MD</au><au>Ruzyllo, Witold, MD, PhD</au><au>Zembala, Marian, MD, PhD</au><au>Osadnik, Tadeusz, MD</au><au>Dubiel, Jacek, MD, PhD</au><au>Zdrojewski, Tomasz, MD, PhD</au><au>Kalarus, Zbigniew, MD, PhD</au><au>Polonski, Lech, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Invasive and Non-Invasive Treatment Strategies in Older Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the Polish Registry of Acute Coronary Syndromes - PL-ACS)</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2011</date><risdate>2011</risdate><volume>107</volume><issue>1</issue><spage>30</spage><epage>36</epage><pages>30-36</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Cardiogenic shock (CS) continues to be the most important factor affecting the mortality rate of patients with acute myocardial infarctions (AMIs). However, controversy regarding the optimal treatment of older patients with AMIs complicated by CS still exists. The aim of this study was to compare the results of invasive (coronary angiography during index hospitalization) and noninvasive treatment strategies in patients aged ≥75 years with AMIs complicated by CS, defined as systolic blood pressure <90 mm Hg or need for hemodynamic support and end-organ hypoperfusion. A multicenter Polish registry that included data on patients with acute coronary syndromes was examined to identify patients with AMIs treated from October 2003 to May 2007. A total of 97,531 patients with AMIs were hospitalized, and 5.5% of those patients (n = 5,390) had CS on admission, including 1,976 patients aged ≥75 years (509 treated invasively and 1,467 treated noninvasively). In-hospital mortality was 55.4% in patients treated invasively and 69.9% in patients treated noninvasively (p <0.0001). After 6 months, the mortality rate was 65.8% in the invasive group and 80.5% in the noninvasive group (p <0.0001). Propensity score analysis, in which 499 patients of each group were analyzed after being matched for demographic and clinical data, confirmed the early and long-term benefits of the invasive strategy. In conclusion, applying the invasive strategy to patients with AMIs complicated by CS reduced in-hospital and 6-month mortality in patients aged ≥75 years.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21146682</pmid><doi>10.1016/j.amjcard.2010.08.039</doi><tpages>7</tpages></addata></record> |
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subjects | Acute coronary syndromes Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Angioplasty, Balloon, Coronary Biological and medical sciences Cardiology Cardiology. Vascular system Cardiovascular Clinical medicine Comparative analysis Coronary Angiography Coronary heart disease Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Female Follow-Up Studies Heart Heart attacks Humans Intensive care medicine Male Medical sciences Myocardial Infarction - complications Myocardial Infarction - mortality Myocardial Infarction - therapy Myocarditis. Cardiomyopathies Older people Patients Poland Registries Shock, Cardiogenic - etiology Treatment Outcome |
title | Comparison of Invasive and Non-Invasive Treatment Strategies in Older Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the Polish Registry of Acute Coronary Syndromes - PL-ACS) |
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