Abstract 13014: Sex-Differences in Nonagenarians With ST Elevation Myocardial Infarction

Abstract

Introduction: Longevity of the population continues to increase but frequently elderly patients are excluded from clinical trials. Women with STEMI have been reported to have higher mortality, delay to treatment, and suboptimal prescription of goal directed medical therapy compared to men. We recently demonstrated higher utilization of PCI with improved outcomes in elderly patients treated in regional STEMI systems with standardized protocols. We evaluated sex-differences in nonagenarians with STEMI. Methods: The Midwest STEMI Consortium (MSC) consists of four regional STEMI centers includes 15,039 consecutive STEMI activations between March 2003 and December 2020. Sex differences were assessed in the subgroup of patients ≥ 90 years old (n=303, 2%), including baseline demographic, intervention, mortality outcomes, and pre/post hospitalization residence status. Results: Of 303 nonagenarians, women (N=194, 64%) were less likely to have a smoking history, family history of coronary artery disease (CAD), and personal history of CAD (including MI, PCI or CABG). Surprisingly, there were no sex differences in time to treatment, use of PCI (84 vs 78%), adjunctive medical therapy or clinical outcomes including in-hospital and 1-year mortality (Table). Conclusions: In 4 established regional STEMI systems, in elderly patients ≥ 90 years old women were more common (64%) and although the risk profiles were different, there were no sex differences in reperfusion strategy, time to treatment, or adjunctive therapy. Importantly, there were no differences in clinical outcomes including mortality. The high rate of PCI, excellent treatment times and clinical outcomes compared to historical data likely reflect the benefit of regional STEMI programs using standardized protocols.