Abstract 11737: Clinical Background and Outcomes of Super-Elderly Patients With Hemodynamically Stable Acute Myocardial Infarction

Abstract

Background and hypothesis: An increasing proportion of the population is living into their nineties and beyond, as are the number of super-elderly patients (over the age of 90 years) who present with acute myocardial infarction (AMI). The decision to perform emergency revascularization in these patients is difficult because they commonly have multiple comorbidities and are at high risk for invasive procedures. Aims: In order to help stratifying decision-making, this study was planned to clarify the clinical background, in-hospital outcome, and effect of primary percutaneous coronary intervention (PPCI) in super-elderly AMI patients with stable hemodynamics on admission. Methods: Between April 2012 and March 2018, 6,427 hemodynamically stable AMI patients over 90 years of age were identified in a nationwide Japanese administrative database (the JROAD-DPC registry). clinical characteristics, in-hospital occurrence of in-hospital adverse outcomes, and the effect of PPCI were examined. Results: The AMI patients included 4,242 females (66.2%) with a mean BMI of 20.7±4.0 and 2,828 patients (44.0%) with Killip class 1 on admission. The rate of 30-day all-cause mortality was 14.0% and full-score Barthel index, an ordinal scale used to measure performance in activities of daily living (ADL), at discharge was 20.8%. In-hospital complications occurred in 38.2% of patients, which consisted of heart failure after admission (16.0%), life-threatening arrhythmia (3.5%), the use of IABP (3.8%), ECMO (0.2%), mechanical respiration (12.8%), dialysis (1.5%), major bleeding (3.6%), sepsis (1.6%), and pneumonia (10.3%). PPCI was performed in 36,79 patients (57.2%). Patients who underwent PPCI had significantly lower 30-day all-cause mortality (9.4% vs 20.2%, p<0.05) and significantly lower major non-cardiac events (14.9% vs 17.1%, p<0.05). Conclusions: Super-elderly AMI patients (≥90 years of age) were at high-risk for in-hospital mortality rates and In-hospital complications, even if they were hemodynamically stable on admission. PPCI is associated with improved in-hospital outcomes. Therefore, PPCI may provide acceptable outcomes even in these super-elderly AMI patients.