Copyright © 2003 by the European Society of Cardiology.
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Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock: a report from the SHOCK Trial Registry
a University of Toronto, Toronto, Ontario, Canada
b University of Alberta Hospital, Edmonton, Alberta, Canada
c New England Research Institutes, Watertown, MA, USA
d Mt. Sinai Medical Center, New York, NY, USA
e University of Michigan Medical Center, Ann Arbour, MI, USA
f University of Arkansas Division of Cardiology, Bronx, NY, USA
g Albert Einstein College of Medicine, Bronx, NY, USA
h St. Luke's-Roosevelt Hospital, New York, NY, USA
i University of Oklahoma Health Science Center, Oklahoma City, OK, USA
j New York Presbyterian Hospital, New York, NY, USA
* Corresponding author. Interventional Cardiology Program, University Health Network, 12-224A Eaton North, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4. Tel.: +1-416-340-4800; fax: +1-416-340-3390
E-mail address: vlad.dzavik{at}uhn.on.ca
Received 3 December 2002; accepted 3 December 2002
Aims The SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK (SHOCK) Trial showed no benefit of early revascularization in patients aged 
75 years with acute myocardial infarction and cardiogenic shock. We examined the effect of age on treatment and outcomes of patients with cardiogenic shock in the SHOCK Trial Registry.
Methods and results We compared clinical and treatment factors in patients in the SHOCK Trial Registry with shock due to pump failure aged <75 years 
and 75 years 
, and 30-day mortality of patients treated with early revascularization <18 hours since onset of shock and those undergoing a later or no revascularization procedure. After excluding early deaths covariate-adjusted relative risk and 95% confidence intervals were calculated to compare the revascularization strategies within the two age groups. Older patients more often had prior myocardial infarction, congestive heart failure, renal insufficiency, other comorbidities, and severe coronary anatomy. In-hospital mortality in the early vs. late or no revascularization groups was 45 vs. 61% for patients aged <75 years 
and 48 vs. 81% for those aged 75 years 
. After exclusion of 65 early deaths and covariate adjustment, the relative risk was 0.76 (0.59, 0.99; 
) in patients aged <75 years and 0.46 (0.28, 0.75; 
) in patients aged 75 years.
Conclusions Elderly patients with myocardial infarction complicated by cardiogenic shock are less likely to be treated with invasive therapies than younger patients with shock. Covariate-adjusted modeling reveals that elderly patients selected for early revascularization have a lower mortality rate than those receiving a revascularization procedure later or never.
Key Words: Cardiogenic shock • Age • Elderly • Revascularization • Prognosis • Survival
List of Abbreviations: CK(-MB), creatine kinase (-MB) • ECG, electrocardiogram, electrocardiography • GUSTO-I, Global Utilization of Streptokinase and TPA (alteplase) for Occluded coronary arteries • IABP, intra-aortic balloon pump • MI, myocardial infarction • PCI, percutaneous coronary intervention • SHOCK, SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? • TIMI, Thrombolysis In Myocardial Infarction
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