Research Fellow Lenox Hill Hospital - Northwell Health Lenox Hill Hospital - Northwell Health New York, New York, United States
Disclosure(s):
Abduljabar Adi, MD: No financial relationships to disclose
Background: Cardiogenic shock (CS) is associated with high mortality, especially in elderly patients. Elderly patients are underrepresented in studies of therapeutic interventions in CS including mechanical circulatory support (MCS). The impact of age on the outcomes of CS patients treated with MCS is incompletely described.
Methods: We compared the baseline characteristics, comorbidities, etiology of shock, adverse events and outcomes between elderly (≥75 years) and non-elderly patients treated with advanced MCS (aMCS). Advanced MCS was defined as any Impella device and/or VA-ECMO. To investigate the differences between the groups we evaluated covariates of interest in univariate models and a stepwise multivariate forward regression model based on clinical characteristics of participants.
Outcome: A total of 578 patients were analyzed, including 106 elderly patients. The average age for elderly patients was 81 ± 5 years, with less males compared to the non-elderly group (59% vs. 74%; p< 0.01). Elderly patients had lower BMI (27 ± 6 vs. 29 ± 1; p< 0.01), but higher prevalence of hypertension (81% vs. 53%, p< 0.01), coronary artery disease (51% vs. 35%, p< 0.01), peripheral artery disease (9% vs. 4%, p=0.02), atrial fibrillation (23% vs. 10%, p< 0.01), and chronic kidney disease (19% vs. 9%, p< 0.01).
Elderly patients had shorter duration of Impella support (median 1 day [IQR=0, 2] vs. 2 days [IQR=0, 5]; p< 0.01in the non-elderly group). However, the duration of VA-ECMO support and the time from admission to MCS initiation were similar.
Complication rates, including bleeding, thrombotic events, acute dialysis, and mortality were similar between groups.
Elderly patients had higher rates of NSTEMI (32% vs. 15%, p< 0.01), whereas STEMI (29% vs. 44%, p=0.01) and cardiac arrest (14% vs. 27%, p=0.01) were more frequent in the non-elderly group. Lactate and creatinine levels at admission were comparable. While left ventricular ejection fraction was similar, elderly patients had smaller LV sizes (LVEDD: 4.8 ± 0.9 vs. 5.4 ± 2.2 cm, p< 0.01).
Conclusion: Elderly CS patients treated with aMCS have more comorbidities, lower STEMI rates, and shorter duration of MCS support with similar complication and mortality rates. Given the high risk for adverse outcomes and difference in utilization of potentially lifesaving interventions, further studies are necessary to evaluate CS interventions in this cohort.
