The management of patients aged 90 years and older with ST-segment elevation myocardial infarction

Abstract

Aim – to study in-hospital outcomes in patients with ST-segment elevation myocardial infarction (STEMI) in the age group over 90 years old, depending on the treatment tactics. Material and methods. For the period of January, 2017 - December, 2020, in total 72 patients aged ≥ 90 were hospitalized in Samara Regional Clinical Cardiology Dispensary with STEMI: mean age 91.8 years (90-96), among them 49 women (68%). Patients were divided into two groups depending on the chosen treatment strategy. Group 1 included patients (n = 13) who underwent coronary angiography and primary percutaneous coronary intervention (pPCI), mean age 90.6 (90-91) years, 8 women (61.5%). Group 2 included patients who received coronary angiography and conservative treatment (n = 5) and only conservative treatment (n = 54), mean age 91.9 (91-96) years, 41 women (69.5%). Results. In terms of the incidence of pulmonary edema and cardiogenic shock, both groups were comparable, no statistically significant differences were found. In-hospital mortality among STEMI patients aged 90 years and older was higher in the conservative treatment group than in the invasive group (45.8% vs. 7.7%) (OR 10.12; 95% CI (1.24–82 .96)). Conclusion. The results obtained in our study may indicate the advantage of the invasive strategy in the treatment of patients with STEMI over the age of 90 years. Further prospective studies based on the principles of evidence-based medicine are required.

Keywords

• stemi
• reperfusion therapy
• elderly
• nonagenarians