Comparison of In-Hospital Clinical Outcomes of Acute Myocardial Infarction Between Nonagenarians and Octogenarians

Abstract

Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Although there are earlier studies regarding AMI in octogenarians, clinical evidences of AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital outcomes of AMI between octogenarians and nonagenarians. We included consecutive 415 very elderly (!80 years) with AMI and divided them into the nonagenarian group (n = 38) and the octogenarian group (n = 377). Clinical characteristics and in-hospital outcomes were compared between the two groups. Furthermore, we used propensity score matching to find the matched octogenarian group (n = 38). Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups. The incidence of inhospital death in the nonagenarian group (10.5%) was similar to that in the octogenarian group (12.5%) (P = 0.487). After using the propensity score matching, the incidence of in-hospital death was less in the nonagenarian group (10.5%) than in the matched octogenarian group (18.4%) without reaching statistical significance (P = 0.328). The length of hospitalization was significantly shorter in the nonagenarian group [7.0 (4.0-9.0)] than in the matched octogenarian group [10.0 (6.5-15.0)] (P = 0.01). In conclusion, the in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed.

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

“…Percutaneous coronary intervention remains the most effective treatment for acute MI patients, and our data demonstrated that also in the oldest subjects, the proportion of patients managed invasively has increased significantly in recent years in Poland. 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].…”

“…Myocardial infarction (MI) has been consi dered a major cause of death in developed countries. The prevalence of MI and mortality in MI patients is strongly influenced by age [1][2][3][4]. The evidence on changes in survival and management in nonagenarians with acute coronary artery disease in recent years is limited.…”

Managing Nonagenarians with Acute Myocardial Infarction: Invasive versus Conservative Treatment

“…Thus, many older patients are still undertreated conservatively in real-world practice regardless of PCI feasibility. [ 1 , 3 , 5 , 12 , 13 , 16 – 20 ].…”

Factors Associated with In-Hospital Death in Patients with Killip Class 3 Acute Myocardial Infarction

“…19) Diabetes mellitus was defined as hemoglobin A1c "6.5% (national glycolhemoglobin standardization program (NGSP) value) or treatment for diabetes mellitus. 20,21) Dyslipidemia was defined as total cholesterol " 220 mg/dL, low-density lipoprotein cholesterol " 140 mg/dL, or treatment for dyslipidemia. 22) We used the laboratory data at admission.…”