ArticleAmerican heart journal2025
Clinical outcomes and discharge disposition in nonagenarians with ST-elevation myocardial infarction.
Article in American heart journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNonagenarians with ST-elevation myocardial infarction (STEMI) represent a unique and growing population and are underrepresented in clinical trials due to arbitrary exclusion criteria. Therefore, a thorough examination of STEMI in this age population may better inform management decisions.
methodsThis is a cohort study examining the Midwest STEMI Consortium database from March 2003 through October 2020. All patients with STEMI, presenting within 24 hours of symptom onset, were enrolled -including those with advanced age, cardiogenic shock, or out-of-hospital cardiac arrest. Data are described across age groups: <70, 70-79, 80-89, and ≥90 years. Main outcome measures were discharge disposition; mortality in-hospital, 30-days, and 1-year.
resultsAmong 15,039 consecutive STEMI patients, 303 (2%) were ≥90 years, of whom 194 (64%) were females. Among nonagenarians, mortality was 17% in the hospital, 20% at 30-day, and 33% at 1-year; and those living in a skilled nursing facility (SNF) before presentation had significantly higher in-hospital mortality (36%) versus those living at home or in an assisted living facility (ALF) (14% and 15% respectively). The mortality at 1 year was 13% for patients discharged to home, 20% for those discharged with home health care or ALF, and 43% for those discharged to SNF (P < .001).
conclusionsIn this large multicenter prospective STEMI database, nonagenarians living in SNF before presentation had more than 2-fold higher in-hospital mortality than those living at home. Furthermore, patients discharged to SNF had a 3-fold higher 1-year mortality than those discharged to home. In this older STEMI population, living status before the presentation and at hospital discharge carries important prognostic information.
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