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Funding Acknowledgements Type of funding sources: None. Introduction  Nonagenarians have a high rate of comorbidities and are underrepresented in studies of ischemic heart disease. It is unknown whether treatment at discharge is useful in preventing adverse events at follow up.  Purpose  The aim of this study is to evaluate the secondary prevention with medical treatment in nonagenarians with acute myocardial infarction. Methods A multicenter, observational and retrospective study was carried out in nonagenarians admitted by acute coronary syndrome (ACS) between January 2005 and December 2018. Baseline characteristics, interventional procedures, treatment at discharge and outcomes at 1 year were evaluated. Patients with type 2 acute myocardial infarction were excluded.  Results  680 patients (92,6 ± 2,4 years old) were included. Hypertension was present in 79.4% of the entire population. Percutaneous coronary intervention (PCI) was performed in 32.1% of patients, and this group had a higher GRACE score compared to the conservative treatment group (177 versus 172; p = 0.001). Patients with ST-segment elevation myocardial infarction (STEMI) were more likely to receive an invasive strategy than the non-ST segment elevation myocardial infarction (NSTEMI) (61.5% versus 41.5%; p= 0.001). 263 patients died at 1 year follow up with in-hospital mortality of 17%. In STEMI group, patients with statins and dual antiplatelet therapy at discharge had lower mortality during follow up compared to those who did not received (26.7 % versus 41.5%; p = 0.001 and 31% versus 22%; p = 0.02, respectively) (Image 1).  Conclusions Nonagenarian patients with ACS have a high prevalence of hypertension and ICP procedures are not performed frequently. They also have a high mortality rate, although statins and dual antiplatelet therapy could be an effective secondary prevention. Abstract Figure.

Funding Acknowledgements Type of funding sources: None. Background Ischemic heart disease in the elderly people has increased accordingly with rising hope of life. In patients with acute coronary syndrome (ACS) women have a higher mortality than men. However, it is unknown if these differences remain in nonagenarians. Purpose The aim of the study was to evaluate the therapeutic strategies and mortality at 1 year according to gender. Methods We retrospectively included in a multicenter study  all consecutive patients > 90 yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) between 2005 and 2018. Strategies treatment and mortality at 1 year by gender were evaluated. Results 680 patients were included (92.6 ± 2.4 years, 59% women) (Table 1). Women presented a greater prevalence of hypertension arterial. Conservative treatment was more frequent in women (73.5% vs 66.2%, p = 0.04) (Image 1), in particular in STEMI subgroup (p = 0.01). They had less capacity functional evaluated by Barthel index (p <0.01) and higher number of infections during admission than men (17.45% vs. 11.7%, p <0.01). The mortality evaluated at 12 months was similar in both groups (p = 0.38), with a trend of better prognosis in women who underwent percutaneous coronary intervention (PCI) (p = 0.08). Conclusions Women had lower functional capacity than men, which could explain that they were more likely to be treated with conservative strategy. Mortality was similar in both genders, however, in the subgroup of patients undergoing PCI, was achieved a trend of lower mortality in women. WomenMenPPatients402.0 (59,1%)278.0 (40,9%)Age92.5 ± 2,292.6 ± 2,50.82STEMI189.0 (47%)120.0 (43%)0.32Hypertension331.0 (82,6%)208.0 (74,8%)0.01CKD84.0 (20,9%)59.0 (21,2%)0.91COPD17.0 (4,2%)54.0 (19,4%)<0.01Barthel index75.084.0<0.01Atypical symptoms82.0 (20,4%)42 (15,1%)0.08GRACE175.0171.00.02LDL97.086.0<0.07PCI44,8%54,3%0.04All cause mortality150.0 (37,3%)113.0 (40,6%)0.38Cardiovascular mortality97.0 (67,8%)63.0 (58,3%)0.12

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