AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Age-Stratified Outcomes Following Non-ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: A Propensity-Matched Analysis
By Haddad F, Bhatt P, Sanusi M et al.
Background: Cardiogenic shock (CS) remains the leading cause of mortality following acute myocardial infarction despite advances in cardiovascular care. Older adults comprise an increasing proportion of patients with non-ST-elevation myocardial infarction (NSTEMI) complicated by CS, yet outcomes across elderly age groups remain incompletely characterized. We evaluated the impact of age on outcomes among patients with NSTEMI-CS. Methods: Using the TriNetX Global Collaborative Network, we identified adults with NSTEMI who developed CS within 7 days of the index event. Patients were stratified into three age groups: 65-74 years (n=14,876), 75-84 years (n=16,604), and 85-100 years (n=14,015). A propensity score-matched analysis compared patients aged 65-74 and 85-100 years, adjusting for demographics, hypertension, diabetes mellitus, heart failure, atrial fibrillation/flutter, chronic kidney disease, chronic obstructive pulmonary disease, pulmonary hypertension, obesity, and obstructive sleep apnea (Table 1). After matching, 10,435 patients remained in each cohort. Outcomes were assessed at 180 days. Results: Mortality increased progressively with age. Among unmatched cohorts, all-cause mortality was 12.5% in patients aged 65-74 years, 14.1% in those aged 75-84 years, and 17.0% in those aged 85-100 years. Kaplan-Meier analysis demonstrated significantly higher survival among patients aged 65-74 years compared with those aged 85-100 years (HR 0.67, 95% CI 0.61-0.73; p<0.001) (Figure 1). Conversely, the younger cohort experienced higher rates of ventricular tachycardia/ventricular fibrillation/cardiac arrest (3.37% vs 1.66%; HR 1.51, 95% CI 1.20-1.92; p<0.001), heart failure hospitalization (2.96% vs 1.91%; RR 1.55, 95% CI 1.17-2.07; p=0.002), and implantable cardioverter-defibrillator implantation (0.80% vs 0.27%; HR 2.38, 95% CI 1.54-3.67; p<0.001) (Table 2). Rates of percutaneous coronary intervention, cardiac resynchronization therapy implantation, permanent pacemaker implantation, and palliative care utilization were similar . Conclusions: Among patients with NSTEMI-CS, advancing age was associated with progressively higher mortality, with the greatest risk observed in those aged 85-100 years. Despite lower mortality, patients aged 65-74 years experienced greater long-term cardiovascular morbidity, including ventricular arrhythmias, heart failure hospitalization, and implantable cardioverter-defibrillator implantation. These findings may aid risk stratification and post-discharge management of elderly patients with NSTEMI-CS.