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Title: Specialist Revascularization Services Might Not Influence Survival In Elderly

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American Heart Journal 2002 Vol 143 No 5 pp 768. "Cardiogenic shock complicating acute myocardial infarction in elderly patients: Does admission to a tertiary center improve survival?"
06/13/2002 11:50:13 AM
By Veronica Rose

Specialist centres with revascularisation capabilities do not seem to influence survival of patients with acute myocardial infarction and cardiogenic shock. Doctors at Yale University School of Medicine and the Centre for Outcomes Research and Evaluation Yale-Newhaven Hospital, Connecticut, United States, investigated the potential for improved survival of elderly patients with myocardial infarction. They had noted that the role of early revascularization among patients with acute myocardial infarction (AMI), complicated by cardiogenic shock had remained controversial. In addition, although previous reports had suggested benefits from the process, these had not been subjected to clinical trials. This study was designed to determine if the survival rate for elderly patients with this diagnosis could be improved through early admission to cardiovascular resources at the admitting hospital. Patients of 65 years and above were identified through a retrospective medical record review of Medicare patients discharged with myocardial infarction. Details of 601 patients were provided by the Cooperative Cardiovascular Project database and, of these, 287 (47.8 percent) entered hospital where there were no revascularization facilities. However, 314 (52.2 percent) were admitted to hospitals which offered coronary angioplasty and coronary bypass surgical services. It was noted that across the subgroups there were similar clinical characteristics. There was a greater likelihood of patients undergoing coronary revascularization during the initial hospitalisation period and throughout the first post AMI month in a tertiary centre setting. Following adjustment for demographic, clinic, hospital, and therapeutic strategies, researchers established that the presence of revascularization services was not associated with a noticeably lower 30- day or one-year mortality rate. The odds ratio for the former were 0.83, 95 percent CI 0.47.1.45. and the latter, 0.91.95 percent CI 0.49, 0.72.

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