Outcomes of Nonagenarians With ST Elevation Myocardial Infarction

Area of Science:

• Cardiology
• Geriatric Medicine
• Interventional Cardiology

Background:

• Older adults represent a growing demographic for cardiovascular diseases.
• Nonagenarians with ST-segment elevation myocardial infarction (STEMI) are underrepresented in clinical trials.
• Understanding STEMI management in the very elderly is crucial.

Purpose of the Study:

• To analyze the clinical presentation and outcomes of nonagenarian patients with STEMI.
• To compare in-hospital and 1-year outcomes between optimal medical treatment and primary percutaneous coronary intervention (pPCI).

Main Methods:

• Retrospective analysis of 167 nonagenarian STEMI patients (2006-2018) from two academic centers.
• Assessment of in-hospital and 1-year all-cause mortality.
• Comparison of outcomes between patients receiving optimal medical treatment versus pPCI.

Main Results:

• Overall in-hospital mortality was 22%, and 1-year mortality was 41%.
• The pPCI group showed significantly lower in-hospital (12% vs. 32%) and 1-year mortality (26% vs. 45%) compared to the medical treatment group.
• Independent predictors of 1-year mortality included mechanical complications, Killip class III/IV, elevated creatinine, and absence of pPCI.

Conclusions:

• STEMI in nonagenarians is a growing clinical challenge.
• Primary percutaneous coronary intervention (pPCI) appears to be a preferred strategy for eligible nonagenarian STEMI patients.
• Prognosis is influenced by hemodynamic compromise, myocardial infarction complications, renal function, and timely revascularization.