Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related cardiogenic shock

作     者：Miquel Gual Albert Ariza-Solé María García Márquez Cristina Fernández JoséL Bernal Francesc Formiga María-Isabel Barrionuevo JoséC Sánchez-Salado Victòria Lorente Júlia Pascual Isaac Llaó Oriol Alegre Angel Cequier Javier Elola Miquel Gual;Albert Ariza-Solé;María García Máquez;Cristina Fernández;José L Bernal;Francesc Formiga;María-Isabel Barrionuevo;José C Sánchez-Salado;Victòria Lorente;Júlia Pascual;Isaac Llaó;Oriol Alegre;Angel Cequier;Javier Elola

作者机构：Hospital Universitari de BellvitgeL’Hospitalet de LlobregatBarcelonaSpain Fundación Instituto para la Mejora de la Asistencia SanitariaMadridSpain Hospital Clínico Universitario San CarlosMadridSpain Hospital Universitario 12 de OctubreMadridSpain 

出 版 物：《Journal of Geriatric Cardiology》 (老年心脏病学杂志（英文版）)

年 卷 期：2020年第17卷第10期

页      面：604-611页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：the Fundación Interhospitalaria para la Investigación Cardiovascular and Laboratorios Menarini S.L.(RECALCAR Project).All authors had no conflicts of interest to disclose.The authors thank the Spanish Ministry of Health Consumer Affairs and Social Welfare for the help provided to the Spanish Society of Cardiology to develop the RECALCAR study with special gratitude to the General Directorate of Public Health Quality and Innovation. 

主　　题：Cardiogenic shock Diabetes mellitus Myocardial infarction Revascularization The elderly 

摘      要：Background The prognostic role of diabetes mellitus(DM)in elderly patients with myocardial infarction-related cardiogenic shock(MI-CS)remains controversial.Little information exists about the impact of intensive cardiac care unit(ICCU)and revascularization on outcomes of elderly patients with MI-CS.We aimed to assess the prognostic impact of DM according to age in patients with MI-CS,and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages.Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System’s Basic Data Set.Centers were classified according to their availability of ICCU.Main outcome measured was in-hospital mortality.Results A total of 23,590 episodes of MI-CS were identified,of whom 12,447(52.8%)were in patients aged≥75 years.The impact of DM on in-hospital mortality was different among age subgroups.While in younger patients,DM was associated to a higher mortality risk(0.52 vs.0.47,OR=1.12,95%CI:1.06–1.18,χ^20.001),this association became non-significant in older patients(0.76 vs.0.81,χ^2=0.09).Adjusted mortality rate of MI-CS aged≥75 years was lower in patients admitted to hospitals with ICCU(adjusted mortality rate:74.2%vs.77.7%,P0.001)and in patients undergoing revascularization(74.9%vs.77.3%,P0.001).Conclusions Prognostic impact of DM in patients with MI-CS was different according to age,with a significantly lower impact at older ages.The availability of ICCU and revascularization were associated with better outcomes in these complex patients.