In‐hospital mortality and readmission after ST‐elevation myocardial infarction in nonagenarians: A nationwide analysis from the United States

Abstract

Objectives To assess readmission rates in nonagenarians (age ≥ 90 years) with ST‐elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) versus no pPCI. Background There are limited data exploring readmissions following STEMI in nonagenarians undergoing pPCI versus no pPCI. Methods We retrospectively analyzed the Nationwide Readmissions Database to identify nonagenarians hospitalized with STEMI. We divided the cohort into two groups based on pPCI status. We compared mortality during index hospitalization and during 30‐day readmission, readmission rates, and causes of readmissions. Results We identified 58,231 nonagenarian STEMI hospitalizations between 2010 and 2018, of which 18,809 (32.3%) included pPCI, and 39,422 (67.7%) had no pPCI. Unadjusted unplanned 30‐day readmission was higher in pPCI cohort (21.0% vs. 15.4%, p < 0.001). However, mortality during index hospitalization and during 30‐day readmission were significantly lower in pPCI cohort (15.8% vs. 32.2%, p < 0.001; 7.4% vs. 14.2%, p < 0.001, respectively). After adjusting for baseline characteristics, hospitalizations that included pPCI had 25% greater odds of unplanned 30‐day readmission (adjusted odds ratio [aOR]: 1.25, 95% confidence interval [CI]: 1.12–1.39, p < 0.001) and 49% lower odds of in‐hospital mortality during index hospitalization (aOR: 0.51, 95% CI: 0.46–0.56, p < 0.001). Heart failure was the most common cause of readmission in both cohorts followed by myocardial infarction. Conclusions In nonagenarians with STEMI, pPCI is associated with slightly higher 30‐day readmission but significantly lower mortality during index hospitalization and during 30‐day readmission than no pPCI. Given the overwhelming mortality benefit with pPCI, further research is necessary to optimize the utilization of pPCI while reducing readmissions following STEMI in nonagenarians.

Survival in nonagenarians with acute myocardial infarction in 2014–2020: A nationwide analysis

“…However, the pro portion is still significantly lower when compared with younger adults in Poland [3]. A national analysis in the United States concluded that PCI is related to better sur vival of acute MI patients over 90 years of age [7]. Similar conclusions could be drawn based on analyses from other countries [8][9][10].…”

Trends in primary percutaneous coronary intervention for the treatment of acute coronary ST-elevation myocardial infarction in Latin American countries: insights from the CECI consortium

“…In the cohort of patients aged >90 years, there were worse door-to-balloon times, and they had more complex lesion morphology, with more LMCA involvement (p < 0.001). However, cardiogenic shock and in-hospital mortality did not differ, highlighting the importance of pPCI in this subgroup (18).…”

STEMI in nonagenarians: Never too old

“…Despite some of us being reluctant to perform invasive procedures on the very elderly, we are repeatedly provided data supporting more aggressive and invasive care for the very elderly population. Now Ismayl et al have provided us with more of that sort of evidence 1 …”

“…Now Ismayl et al have provided us with more of that sort of evidence. 1 Ismayl et al report outcomes in nonagenarians admitted with ST-elevation myocardial infarction (STEMI) stratified by whether or not they had a primary percutaneous coronary intervention (pPCI).…”