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Invasive Strategy Can Reduce Mortality in Elderly With MI

Coronary angiography is helpful in patients aged 75 years or older in cardiogenic shock

THURSDAY, Jan. 6 (HealthDay News) -- Applying the invasive strategy of coronary angiography to older patients with acute myocardial infarctions (AMIs) complicated by cardiogenic shock reduces in-hospital and six-month mortality rates, according to research published in the January issue of The American Journal of Cardiology.

Mariusz Gasior, M.D., Ph.D., of the Medical University of Silesia in Zabrze, Poland, and colleagues examined a multicenter database from the Polish Registry of Acute Coronary Syndromes, and identified 97,531 patients with AMIs who had been treated from October 2003 to May 2007; 5,390 had cardiogenic shock on admission.

The researchers found that, of the 1,976 patients who were at least 75 years old, 509 were treated invasively and 1,467 were treated noninvasively. In-hospital mortality was 55.4 percent in those who underwent invasive treatment and 69.9 percent in those treated noninvasively. After six months, the mortality rate was 65.8 percent for those treated invasively and 80.5 percent for those treated noninvasively. The researchers used propensity score analysis, in which 499 patients from each group were analyzed after being matched for clinical and demographic data, to confirm the benefits of the invasive strategy.

"The significant death reduction obtained through application of the invasive strategy holds for a period of six months, which suggests that the early survival benefit establishes longer term survival rather than prolonging eventual demise," the authors write.

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