Management and predictors of event-free survival in nonagenarians with myocardial infarction: A nationwide analysis

Background: Myocardial infarction (MI) remains the leading cause of death, especially in the elderly. Aims:To characterize management and factors related to event-free survival in patients with acute MI aged at least 90 years. Methods: We included all patients aged at least 90 years hospitalized for MI in Poland between 2014 and 2020 and followed them for one year. Results: A total of 14 970 patients (median age 92.7 [90.9-93.8] years) were included (4666 men and 10 304 women). Coronary angiography was performed in 47.0% of patients, percutaneous coronary intervention in 39.8%, and coronary artery bypass grafting in 0.2%. In-hospital mortality was 27.8% (25.1% in men and 29.0% in women; P <0.001). Variables independently related to the higher risk of in-hospital death were age and history of stroke, while male sex, hypertension, history of MI, and invasive management were related to a lower risk of in-hospital death. One-year all-cause mortality following discharge was 38.1% (females: 38.4%, males: 37.5%; P = 0.27), the endpoint consisting of all-cause death, MI, or stroke occurred in 42.6% patients (females: 42.8%, males: 42.2%; P = 0.44), while all-cause death or cardiovascular hospitalization occurred in 59.0% (females: 58.2%, males: 60.7%; P = 0.046). Variables independently related to the higher risk of post-discharge death were age, heart failure, atrial fibrillation, diabetes, and chronic obstructive pulmonary disease. Participation in the managed care program following MI was linked to a lower risk of death or hospitalization for cardiovascular reasons. Conclusions: Variables independently related to the higher risk of post-discharge death among patients hospitalized for MI aged at least 90 years were age, heart failure, atrial fibrillation, diabetes, and chronic obstructive pulmonary disease.When managed invasively, males have lower in-hospital mortality but higher post-discharge mortality than females.