{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T04:24:07Z","timestamp":1784953447553,"version":"3.55.0"},"reference-count":29,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:00:00Z","timestamp":1736812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Cardiogenic shock (CS) is the most frequent cause of in-hospital mortality after ST-elevation myocardial infarction (STEMI). Data about CS in very elderly (age \u2265 85 years) STEMI patients are scarce. We sought to assess the prognostic factors and the short- and mid-term impact of CS in this population. Methods: Consecutive very elderly STEMI patients undergoing invasive treatment were included in a retrospective multicenter registry. Results: Among 608 patients, 72 (11.8%) fulfilled experienced CS. Peripheral artery disease (PAD) (OR: 2.25, 95% CI: 1.29\u20133.92, p &lt; 0.01) and cardiac arrest at presentation (OR: 4.36, 95% CI: 2.32\u20138.21, p &lt; 0.01) were the major independent predictors of CS. Age (HR: 1.07, 95% CI: 1.03\u20131.11, p &lt; 0.001), PAD (HR: 1.29, 95% CI: 1.01\u20131.66, p = 0.045), previous MI (HR: 2.16, 95% CI: 1.32\u20133.55, p = 0.002), and cardiac arrest at presentation (HR: 1.59, 95% CI: 1.29\u20131.96, p &lt; 0.001) were the major independent predictors of death. CS was associated with a higher risk of mortality at 30 days (adjusted HR: 4.21, 95% CI: 2.19 to 7.78, p &lt; 0.01) mostly driven by higher intraprocedural and in-hospital mortality. Among patients who survived the acute phase and hospitalization, CS at presentation was not associated with a higher mortality risk during the remaining follow-up period (log-rank p = 0.78). Conclusions: At short-term follow-up, very elderly STEMI patients presenting with CS had a higher risk of mortality when compared to non-CS patients. Interestingly, CS patients surviving the acute phase showed a similar survival rate to non-CS patients after discharge.<\/jats:p>","DOI":"10.3390\/jcm14020504","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T11:28:31Z","timestamp":1736854111000},"page":"504","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predictors and Impact of Cardiogenic Shock in Oldest-Old ST-Elevation Myocardial Infarction Patients"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6939-2159","authenticated-orcid":false,"given":"Luca","family":"Donazzan","sequence":"first","affiliation":[{"name":"Department of Cardiology, San Maurizio Hospital, 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7492-4749","authenticated-orcid":false,"given":"Alessandro","family":"Ruzzarin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, San Maurizio Hospital, 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Muraglia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9458-0736","authenticated-orcid":false,"given":"Enrico","family":"Fabris","sequence":"additional","affiliation":[{"name":"Cardiothoracovascular Department, University of Trieste, 34149 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6506-8397","authenticated-orcid":false,"given":"Monica","family":"Verdoia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ospedale degli Infermi, ASL Biella, 13875 Biella, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7217-4961","authenticated-orcid":false,"given":"Filippo","family":"Zilio","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9158-0765","authenticated-orcid":false,"given":"Giorgio","family":"Caretta","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Sant\u2019Andrea Hospital, ASL 5 Liguria, 19121 La Spezia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Pezzato","sequence":"additional","affiliation":[{"name":"Cardiothoracovascular Department, University of Trieste, 34149 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5150-188X","authenticated-orcid":false,"given":"Gianluca","family":"Campo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliera-Universitaria di Ferrara, 44124 Cona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8175-276X","authenticated-orcid":false,"given":"Matthias","family":"Unterhuber","sequence":"additional","affiliation":[{"name":"Department of Cardiology, San Maurizio Hospital, 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e1051","DOI":"10.1161\/CIR.0000000000001214","article-title":"Cardiogenic Shock in Older Adults: A Focus on Age-Associated Risks and Approach to Management: A Scientific Statement From the American Heart Association","volume":"149","author":"Blumer","year":"2024","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kanwar, M., Thayer, K.L., Garan, A.R., Hernandez-Montfort, J., Whitehead, E., Mahr, C., Sinha, S.S., Vorovich, E., Harwani, N.M., and Zweck, E. (2021). Impact of Age on Outcomes in Patients With Cardiogenic Shock. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.688098"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1093\/eurheartj\/ehy462","article-title":"Fourth universal definition of myocardial infarction (2018)","volume":"40","author":"Thygesen","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"34","DOI":"10.2174\/157340308783565456","article-title":"A review of cardiogenic shock in acute myocardial infarction","volume":"4","author":"Khalid","year":"2008","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1002\/ejhf.339","article-title":"Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes","volume":"17","author":"Olivari","year":"2015","journal-title":"Eur. J. Heart Fail."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.1016\/j.jchf.2023.09.025","article-title":"Impact of Female Sex on Cardiogenic Shock Outcomes: A Cardiogenic Shock Working Group Report","volume":"11","author":"Ton","year":"2023","journal-title":"JACC Heart Fail."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Lozano-Jim\u00e9nez, S., Iranzo-Valero, R., Segovia-Cubero, J., G\u00f3mez-Bueno, M., Rivas-Lasarte, M., Mitroi, C., Escudier-Villa, J.M., Oteo-Dominguez, J.F., Vieitez-Florez, J.M., and Villar-Garc\u00eda, S. (2022). Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.912802"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.amjcard.2022.04.047","article-title":"Gender Disparities in Cardiogenic Shock Treatment and Outcomes","volume":"177","author":"Bloom","year":"2022","journal-title":"Am. J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1056\/NEJM199209033271001","article-title":"Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction\u2013results of the survival and ventricular enlargement trial","volume":"327","author":"Pfeffer","year":"1992","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"The AIRE Study Investigators (1993). Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet, 342, 821\u2013828.","DOI":"10.1016\/0140-6736(93)92693-N"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1093\/eurheartj\/ehp139","article-title":"Effects of perindopril on cardiac remodelling and prognostic value of pre-discharge quantitative echocardiographic parameters in elderly patients after acute myocardial infarction: The PREAMI echo sub-study","volume":"30","author":"Nicolosi","year":"2009","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/S0140-6736(00)04560-8","article-title":"Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: The CAPRICORN randomised trial","volume":"357","author":"Dargie","year":"2001","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1056\/NEJMoa2404204","article-title":"Beta-Blocker Interruption or Continuation after Myocardial Infarction","volume":"391","author":"Silvain","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1056\/NEJMoa2401479","article-title":"Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction","volume":"390","author":"Yndigegn","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1080\/AC.65.5.2056244","article-title":"Beta-blockers: Focus on mechanism of action Which beta-blocker, when and why?","volume":"5","author":"Gorre","year":"2010","journal-title":"Acta Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.carrev.2024.06.007","article-title":"The enigma of the \u2018smoker\u2019s paradox\u2019: Results from a single-center registry of patients with STEMI undergoing primary percutaneous coronary intervention","volume":"69","author":"Paradossi","year":"2024","journal-title":"Cardiovasc. Revasc. Med."},{"key":"ref_18","unstructured":"De Luca, G., Algowhary, M., Uguz, B., Oliveira, D.C., Ganyukov, V., Zimbakov, Z., Cercek, M., Jensen, L.O., Loh, P.H., and Calmac, L. (2022). Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS-STEMI COVID-19 Registry. J. Clin. Med., 11."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.ijcard.2016.07.172","article-title":"\u201cSmoker\u2019s paradox\u201d in patients with cardiogenic shock complicating myocardial infarction\u2014A substudy of the IABP-SHOCK II-trial and registry","volume":"222","author":"Saad","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1093\/eurheartj\/ehac515","article-title":"Acute, periprocedural and longterm antithrombotic therapy in older adults: 2022 Update by the ESC Working Group on Thrombosis","volume":"44","author":"Andreotti","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1038\/nrneph.2013.282","article-title":"Acute kidney injury\u2014Epidemiology, outcomes and economics","volume":"10","author":"Rewa","year":"2014","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC Guidelines for the management of peripheral arterial and aortic diseases","volume":"45","author":"Mazzolai","year":"2024","journal-title":"Eur Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.jacc.2017.06.030","article-title":"Biomarker-Based Risk Model to Predict Cardiovascular Mortality in Patients with Stable Coronary Disease","volume":"70","author":"Lindholm","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Gherasie, F.A., Popescu, M.R., Achim, A., and Bartos, D. (2024). Peripheral Arterial Disease in the Context of Acute Coronary Syndrome: A Comprehensive Analysis of Its Influence on Ejection Fraction Deterioration and the Onset of Acute Heart Failure. J. Pers. Med., 14.","DOI":"10.3390\/jpm14030251"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/j.jacc.2022.01.037","article-title":"Outcomes Associated With Peripheral Artery Disease in Myocardial Infarction with Cardiogenic Shock","volume":"79","author":"Mihatov","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e002667","DOI":"10.1161\/JAHA.115.002667","article-title":"Heart Failure Complicating Acute Myocardial Infarction; Burden and Timing of Occurrence: A Nation-wide Analysis Including 86,771 Patients From the Cardiovascular Disease in Norway (CVDNOR) Project","volume":"5","author":"Sulo","year":"2016","journal-title":"J. Am. Heart Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3971","DOI":"10.1002\/ehf2.12995","article-title":"Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure","volume":"7","author":"Padkins","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1093\/ehjacc\/zuaa035","article-title":"Influence of age and shock severity on short-term survival in patients with cardiogenic shock","volume":"10","author":"Jentzer","year":"2021","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_29","first-page":"844","article-title":"Role of beta- blockers in cardiovascular disease in 2019","volume":"72","year":"2019","journal-title":"Rev. Esp. Cardiol. (Engl. Ed.)"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/504\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:28:49Z","timestamp":1759919329000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,14]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14020504"],"URL":"https:\/\/doi.org\/10.3390\/jcm14020504","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,14]]}}}