Evidence map›Paper›PMID 30999991›Full record

ArticleJournal of the American College of Cardiology2019

Percutaneous Coronary Intervention in Older Patients With ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock.

Abdulla A Damluji, Karen Bandeen-Roche, Carol Berkower, Cynthia M Boyd, Mohammed S Al-Damluji, Mauricio G Cohen, Daniel E Forman, Rahul Chaudhary, Gary Gerstenblith, Jeremy D Walston and 2 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American College of Cardiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed
6.1field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

36 citing papers in PubMed, 67 citations in OpenAlex.

  1. Review
  2. Article
  3. Review
  4. Review
  5. Article
  6. Article
  7. Review
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Review
  17. Article
  18. Review
  19. Delirium in older adults after percutaneous coronary intervention: Prevalence, risks, and clinical phenotypes.Cardiovascular revascularization medicine : including molecular interventions · 2023
    Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 5 institutions in 1 country.

Abdulla A DamlujiSinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. Electronic address: Abdulla.Damluji@jhu.edu.
Karen Bandeen-RocheDepartment of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Carol BerkowerSinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland.
Cynthia M BoydDivision of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland.
Mohammed S Al-DamlujiDepartment of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut.
Mauricio G CohenCardiovascular Division, University of Miami, Miami, Florida.
Daniel E FormanGeriatric Cardiology Section, University of Pittsburgh, Pittsburgh, Pennsylvania; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
Rahul ChaudharySinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland.
Gary GerstenblithDivision of Cardiology, Johns Hopkins University, Baltimore, Maryland.
Jeremy D WalstonDivision of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland.
Jon R ResarDivision of Cardiology, Johns Hopkins University, Baltimore, Maryland.
Mauro MoscucciSinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland; University of Michigan Health System, Ann Arbor, Michigan. Electronic address: moscucci@umich.edu.
Johns Hopkins University · USSinai Hospital · USUConn Health · USUniversity of Miami · USUniversity of Pittsburgh · US

Funding

Technological Assessment and Solutions Core - RC4P30AG021334 · NIA · JOHNS HOPKINS UNIVERSITY · PI Jeremy D Walston · 2003 to 2026
$33.2M
NIA NIH HHS P30 AG021334
6 · The paper itself

Abstract

backgroundOlder adults ≥75 years of age carry an increased risk of mortality after ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock.

objectivesThe purpose of this study was to examine the use of percutaneous coronary intervention (PCI) in older adults with STEMI and shock and its influence on in-hospital mortality.

methodsWe used a large publicly available all-payer inpatient health care database sponsored by the Agency for Healthcare Research and Quality between 1999 and 2013. The primary outcome was in-hospital mortality. The influence of PCI on in-hospital mortality was assessed by quintiles of propensity score (PS).

resultsOf the 317,728 encounters with STEMI and shock in the United States, 111,901 (35%) were adults age ≥75 years. Of these, 53% were women and 83% were Caucasians. The median number of chronic conditions was 8 (interquartile range: 6 to 10). The diagnosis of STEMI and cardiogenic shock in older patients decreased significantly over time (proportion of older adults with STEMI and shock: 1999: 42% vs. 2013: 29%). Concomitantly, the rate of PCI utilization in older adults increased (1999: 27% vs. 2013: 56%, p < 0.001), with declining in-hospital mortality rates (1999: 64% vs. 2013: 46%; p < 0.001). Utilizing PS matching methods, PCI was associated with a lower risk of in-hospital mortality across quintiles of propensity score (Mantel-Haenszel odds ratio: 0.48; 95% confidence interval [CI]: 0.45 to 0.51). This reduction in hospital mortality risk was seen across the 4 different U.S. census bureau regions (adjusted odds ratio: Northeast: 0.41; 95% CI: 0.36 to 0.47; Midwest: 0.49; 95% CI: 0.42 to 0.57; South: 0.51; 95% CI: 0.46 to 0.56; West: 0.46; 95% CI: 0.41 to 0.53).

conclusionsThis large and contemporary analysis shows that utilization of PCI in older adults with STEMI and cardiogenic shock is increasing and paralleled by a substantial reduction in mortality. Although clinical judgment is critical, older adults should not be excluded from early revascularization based on age in the absence of absolute contraindications.

Indexed as

Patient SafetyAgedAged, 80 and overCohort StudiesDatabases, FactualFemaleFollow-Up StudiesGeriatric AssessmentHospital MortalityHumansMalePercutaneous Coronary InterventionPropensity ScoreRetrospective StudiesRisk AssessmentShock, Cardiogeniccardiogenic shockmortalityolder adultspercutaneous coronary interventionST-segment elevation myocardial infarction

Identifiers

PMID30999991
PMCPMC7185801
OpenAlexW2939613869

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.