Reperfusion therapy for older patients with acute myocardial infarction and cardiogenic shock.
Yuko Kiyohara, Kota Minami, Lina Freeman et al.
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In 30 seconds
This systematic review and meta-analysis assessed reperfusion therapy versus non-reperfusion care in patients aged ≥75 years with acute myocardial infarction (AMI) and cardiogenic shock (CS). It included 14 prospective or retrospective observational studies involving 4583 patients. Reperfusion therapy, delivered by PCI or CABG, was associated with lower short-term mortality (OR: 0.47; 95% CI: 0.30-0.73), although heterogeneity was high (I 2 = 76.8%). Long-term all-cause mortality did not differ significantly between groups (OR: 0.66; 95% CI: 0.34-1.26).
Key findings
- Across 14 studies and 4583 patients, reperfusion was associated with lower short-term mortality than non-reperfusion care (OR: 0.47; 95% CI: 0.30-0.73).
- Short-term mortality results showed high heterogeneity (I 2 = 76.8%).
- Long-term all-cause mortality did not differ significantly between reperfusion and non-reperfusion groups (OR: 0.66; 95% CI: 0.34-1.26; I 2 = 79.7%).
- Subgroup analyses by ST-segment elevation status were largely consistent with the main findings.
Why it matters
Older adults with AMI and CS are under-represented in clinical trials and face substantial risks, leaving uncertainty about reperfusion’s benefits in this group. This synthesis suggests an association with lower short-term mortality, while not establishing a significant long-term mortality difference. The findings help frame the evidence gap and the need to interpret apparent short-term benefit alongside the observational evidence and its heterogeneity.
What to keep in mind
The evidence came from observational studies, so confounding may affect the associations. Short-term results had high heterogeneity, and long-term results were also heterogeneous.