Abstract 13574: A 5-Year Nationwide Analysis: Management & In-Hospital Outcomes of Acute ST-Elevation Myocardial Infarction in the ≥90-Year-Old
Spandan Desai, Nicholas Roma, Kashyap Shah, Jamshid Shirani- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: The number of individuals living at or beyond age 90 is increasing and many have ischemic heart disease (IHD). There is limited data for management and in-hospital outcomes of acute ST-segment elevation myocardial infarction (STEMI) in this age group.
Methods: National Inpatient Sample 2016-2020 was used to query 1,003,305 hospitalizations for adults with STEMI that were divided into two groups: adults ≥90 years and adults between ages 18 and <90.
Results: 33,515 (3.3%) cases with acute STEMI were observed in ≥90-year-old population group (67% females, 84% Caucasians, p<0.001). There was a decline in annual admissions for acute STEMI in the ≥90-year-old group as listed in Table 1. This group had lower rates of diagnostic and reperfusion therapies (coronary angiography (CA) 41% -vs- 86%, P<0.001, PCI 34.5% -vs- 73.2%, p<0.001, CABG 0.3% -vs- 5.50%, p=0.090, Fibrinolysis 0.2% -vs- 0.8%, p=0.061). Smoking history was observed less often in the ≥90-year-old group (21.5% -vs- 49.6%, p<0.001). Hospital mortality in this group was significantly higher (27.6% -vs- 9.1%, p<0.001) and there were higher rates of complications including AKI (32.6% -vs- 18.9%, p<0.001), CHF (53.6% -vs- 38.5%, p<0.001), ventricular arrhythmias (11.1% -vs- 19.2%, p=0.003), and cardiogenic shock (15.1% -vs- 14.1%, p=0.753). In the ≥90-year-old group that died as compared to ≥90-year-old group that survived, there were lower rates of CA (25% -vs- 44%) and PCI (18% -vs- 36%), all p<0.001. In this same comparison group, there were higher rates of development of AKI- 43.2% -vs- 28.5%, need for ICU- 25.7% -vs- 4.3%, need for vasopressors- 6.7% -vs- 1.6%, and need for mechanical ventilation- 23.0% -vs- 3.2%, all p<0.001.
Conclusions: In the ≥90-year-old population admitted with acute STEMI, there were lower rates of reperfusion therapy while In-hospital mortality and complications rates remain high.