JACC Advances · Sep 17, 2025

Frailty and Age as Predictors of Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock

By Ahmadzai MW, Kunkel JB, Graversen PL et al.

BACKGROUND: Cardiogenic shock is a serious complication of acute myocardial infarction (AMICS) with an in-hospital mortality rate of approximately 50%. Frailty is associated with poor outcomes in general but has been poorly investigated in AMICS. OBJECTIVES: The purpose of this study was to evaluate the independent and combined effects of frailty and age on mortality in AMICS patients. METHODS: We conducted a retrospective observational study using the RETROSHOCK cohort, including 1,716 AMICS patients admitted to 2 tertiary university hospitals in Denmark (2010-2017). Frailty was assessed using the Hospital Frailty Risk Score, with frailty defined as a score ≥5. Patients were further stratified by age ≥70 and <70 years old. In a separate analysis, age was categorized into 5 groups at 10-year intervals. Mortality was assessed at 30 days, 1 year (30-day landmark), and 10 years (30-day landmark). RESULTS: Frailty was present in 22% (n = 381). The median age was 69.5 years (IQR: 61-77). The 30-day mortality rate was 65% in frail patients compared to 51% in nonfrail patients, P < 0.001. The highest mortality was observed in patients aged ≥80 years (82%; P < 0.001) at 30 days, with more than 9-fold adjusted increased risk of death compared to nonfrail patients under 50 years (adjusted HR: 9.18; 95% CI: 4.66-18.1; P < 0.001). Combined analysis of age and frailty demonstrated 73% mortality in frail patients ≥70 years at 30 days and 82% at 10 years (30-day landmark). Frailty remained independently associated with increased risk of mortality (aHR: 1.84; 95% CI: 1.37-2.46; P < 0.001). CONCLUSIONS: Frailty and age are strong, independent predictors of mortality in AMICS.

doi.org/10.1016/j.jacadv.2025.102118 Open access PubMed 40965403 Biomarkers