Outcomes of an Interventional Approach in STEMI and NSTEMI All-Comer Octo and Nonagenarians

The number of octogenarians and nonagenarians presenting with (NSTEMI) is rising. However, they are underrepresented in studies. Therefore, we aim to clarify patient characteristics and compare all-cause mortality of an initial invasive strategy versus optimal medical treatment in (N)STEMI octo and nonagenarians.

All consecutive patients with (N)STEMI admitted from 2020 until 2023 were included. Patients were divided into invasive and OMT groups. Multi-variation corrected analyses were performed in two age groups.

775 consecutive patients > 80 years old were analyzed (81 > 90 years). A predominance of women, lower hemoglobin levels, eGFR, and lower rates of coronary angiography and PCI were observed in the nonagenarians. Six patients underwent CABG; all were in the 80-90-year age group. No differences existed in clinical complication rates between the groups. Invasive treatment demonstrated lower 1 year mortality, predominantly seen in NSTEMI elderly patients.

In octo and nonagenarian (N)STEMI patients, stratifying to an invasive strategy with PCI/CABG appears to be feasible and is associated with improved mortality outcomes. This benefit is predominantly observed in patients with NSTEMI. Stratification can be done immediately on common clinical variables and appropriate shared decision-making.