Abstract 4146996: Trends in the Management and Outcomes of ST Elevation Myocardial Infarction with Cardiogenic Shock in Older Adults: Insights from US National Database

Background: Due to increased life expectancy, there is increasingly high prevalence of myocardial infarction (MI) in older adults (age ≥75 years). Older adults tend to receive less guideline recommended treatment for MI due to associated frailty. We compare the management and outcomes in older adults with ST elevation myocardial infarction (STEMI) and cardiogenic shock (CS) as compared to adults age <75 years. Methods: Nationwide Readmissions Database (2016-2021) was analyzed to study patients with STEMI-CS. Cohort was stratified by age. Mahalanobis Distance Matching within the Propensity Score Caliper was used to match older adults (age ≥75 years) with patients age <75 years. Inverse Probability weighting (IPW) was utilized, and Pearson’s chi-squared test was applied to the PSM-2 matched cohorts to compare outcomes. Results: Among 177,874 hospitalizations of STEMI-CS, more than half (57.7%) were older adults (age ≥75). After propensity matching (N: 55,855 in each group), older adults were less likely to receive PCI (60.6% vs. 62.2%, aOR: 0.93 [95% CI], p <0.001) and had a higher mortality (45.2% vs. 33.9%, aOR:1.75 [95%CI], p <0.001) as compared to patients age <75 years. From the year 2016-2021, mortality of STEMI-CS has remained unchanged for older adults (mean: 43%) (p-trend >0.05). Moreover, an alarming decline for PCI for older adults was also noted (59.4% to 44%, p-trend<0.001). Conclusion: Older adults are less likely to receive PCI and have a higher mortality compared as to patients age <75 years when presenting with STEMI and cardiogenic shock. Focused initiatives are needed to improve STEMI care in older adults.