Abstract 12130: Age Stratified Analysis in Acute Myocardial Infarction Cardiogenic Shock. Insights From the National Cardiogenic Shock Initiative

Background:The National Cardiogenic Shock Initiative (NCSI) is a single-arm, prospective, multicenter study to assess clinical outcomes associated with early mechanical circulatory support (MCS) in patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) treated with percutaneous coronary intervention (PCI).Methods:From July 2016 to May 2019, patients who presented with AMICS to the 65 participating hospitals were included in the study and were treated using a standard protocol with invasive hemodynamic monitoring, early MCS and PCI. Patients were stratified based on the age and 4 cohorts were generated: <50, 50-59, 60-69, and >=70 years old.Results:A total of 213 patients were included, 28 were <50 years old, 55 were 50 to 59 years old, 58 were 60 to 69 years old, and 73 were >=70 years old. There was significantly difference in mortality among groups; using patients younger than 50 years old as the reference (35.6% mortality), the mortality for patients aged 50 to 59 was 25.5% (OR: 9.22 p=0.037), 34.5% for patients 60 to 69 years old (OR: 14.2, p=0.012), and 42.5% for patients 70 years or older (OR: 19.2, p=0.004). A lactic acid greater than 4 mmol/dl was associated with higher mortality in older cohorts.There was no significant difference in the rates of acute kidney injury among cohorts. Patients in the younger cohorts required additional support and had longer length of stay when compared to the older cohorts. Radial access was less commonly used in patients older than 70 years old (13.7%) and more common in younger than 50 years old (28.6%).Conclusion:The odds of inpatient mortality is proportional to the patient age group, which could be as high as 20 times higher for patients 70 years and older, 14 times higher in patients 60 to 69 years old, and 9 times higher in patients 50 to 59 years old, when compared with patients younger than 50 years old. There is a cumulative risk with age and a lactic acid greater than 4 mmol/dl to predict mortality in AMICS.