Abstract 15218: Contemporary Management and Outcomes of Nonagenarians with Acute Myocardial Infarction

Abstract

Objectives: We sought to describe management patterns and outcomes of nonagenarians presenting with STEMI in a large, representative hospital sample.

Methods: We used data from the Nationwide Inpatient Sample, a database of hospital discharges designed to approximate a 20% sample of all US hospitals. STEMI cases, management patterns, and comorbidities were identified using ICD9 codes. Patients who were transferred to other acute care facilities (3.7% of nonagenarians and 11.3% of younger age groups) were excluded from management and outcome analyses.

Results: We identified 374,473 STEMI hospitalizations from 2002 to 2009, 3% (n=12,123) of which were nonagenarians. Nonagenarians were less likely to receive diagnostic angiogram or revascularization, compared to younger patients (Table 1). While 8% of patients aged 18 to 89 died, 26% of nonagenarians died during hospitalization (p<0.01). Among nonagenarians, 15% of those who received PCI died, compared to 28% of those who did not receive PCI (p<0.01). For other revascularization methods, 21% of nonagenarians who received CABG and 50% of nonagenarians who received fibrinolytics died. In univariate analysis, revascularization (PCI, CABG, or fibrinolytics) protected against death among nonagenarians (OR 0.45, 95% CI 0.39 to 0.51). Adjustment for sex and comorbid conditions did not appreciably alter these results (OR 0.44, 95% CI 0.39 to 0.51).

Conclusions: Mortality for STEMI hospitalizations among nonagenarians is high. Revascularization is used infrequently, but it appears to have favorable mortality outcomes among those selected for revascularization in this representative hospital sample. In subsequent analyses, we plan to add additional years of data and identify predictors of revascularization.