ST‐elevation myocardial infarction in nonagenarians: A nationwide analysis of trends and outcomes in the United States

Abstract

Objective To assess ST elevation myocardial infarction (STEMI) trends and outcomes in nonagenarians undergoing primary percutaneous coronary intervention (pPCI) compared to medical management. Background Although nonagenarians (age greater than 90 years) represent the fast‐growing age decade of the US population, limited evidence is available regarding trends and outcomes of treatment strategies for STEMI in this population cohort. Methods We performed a retrospective analysis using the National Inpatient Sample (NIS) database to identify nonagenarians presenting with STEMI and treated with either pPCI or medical management. In‐hospital mortality, in‐hospital complications, length of stay and in‐hospital costs were analyzed. Results Between 2010–2017, 41,042 STEMI hospitalizations were identified in nonagenarians, of which 11, 155 (27.2%) included pPCI whereas 29, 887 (72.8%) included medical management. STEMI hospitalizations among nonagenarians decreased over the study period. Overall unadjusted in‐hospital mortality was 21.6%, and the hospitalizations that included pPCI had significantly lower mortality compared to the medical management (13.6% vs. 24.5%, p < .001). After adjusting for baseline characteristics, hospitalizations that included pPCI had 42.1% lower odds of in‐hospital mortality (adjusted OR: 0.58, 95% CI: 0.50 to 0.67, p < .001). Altogether, in‐hospital cardiac, bleeding and vascular complications, length of stay and in‐hospital costs were higher in pPCI hospitalizations. Conclusion In nonagenarians, STEMI mortality is high, but pPCI is associated with superior outcomes compared to medical management alone. Therefore, pPCI can be considered an acceptable treatment strategy in this population.

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

“…After adjusting for demographic and clinical characteristics, hospitalizations that included pPCI had 49% lower odds of in‐hospital mortality during index hospitalization (aOR: 0.51, 95% CI: 0.46–0.56, p < 0.001). The lower in‐hospital mortality with pPCI was consistent across all elderly age groups and is congruent with prior work, including our own, that demonstrated lower morbidity and mortality in elderly STEMI patients undergoing prompt pPCI compared to thrombolytic therapy or medical management alone 12,21 . However, as supported by Angelini et al, 22 nonagenarians with STEMI undergoing pPCI have higher in‐hospital mortality rates compared to younger age groups (4.9% [65–69 years] vs. 15.8% [≥90 years], p < 0.001; Table 7), and living independently is a strong independent predictor of survival to hospital discharge 22 .…”

“…By examining the rates, trends, and causes of readmission after STEMI specifically in nonagenarians over a long period (2010–2018) and comparing those rates with elderly of younger age groups (65–69, 70–74, 75–79, 80–84, and 85–89), the current study expands on previous work, including our own, that examined index hospitalization outcomes in nonagenarians with STEMI, 1,12 in addition to other studies focusing on readmission after STEMI in younger age groups 6,13 …”

“…By examining the rates, trends, and causes of readmission after STEMI specifically in nonagenarians over a long period (2010-2018) and comparing those rates with elderly of younger age groups (65-69, 70-74, 75-79, 80-84, and 85-89), the current study expands on previous work, including our own, that examined index hospitalization outcomes in nonagenarians with STEMI, 1,12 in addition to other studies focusing on readmission after STEMI in younger age groups. 6,13 This large NRD study demonstrated three principal findings: (a) in nonagenarian STEMI patients who underwent pPCI during index hospitalization, the overall and unplanned 30-day readmission rates were slightly higher compared to those who did not undergo pPCI; (b) however, in-hospital mortality rates during index hospitalization and during 30-day readmission and recurrent myocardial infarction (MI) rates were significantly lower in the pPCI cohort compared to the no pPCI cohort; (c) heart failure was the most common cause of 30-day readmission in both cohorts, followed by AMI and gastrointestinal hemorrhage.…”