Management and predictors of event-free survival in nonagenarians with myocardial infarction: A nationwide analysis
Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Myocardial infarction (MI) remains the leading cause of death, especially in the elderly. AIMS: To characterize management and factors related to event-free survival in patients with acute MI aged at least 90 years. METHODS: We included all patients aged at least 90 years hospitalized for MI in Poland between 2014 and 2020 and followed them for one year. RESULTS: A total of 14 970 patients (median age 92.7 [90.9-93.8] years) were included (4666 men and 10 304 women). Coronary angiography was performed in 47.0% of patients, percutaneous coronary intervention in 39.8%, and coronary artery bypass grafting in 0.2%. In-hospital mortality was 27.8% (25.1% in men and 29.0% in women; P <0.001). Variables independently related to the higher risk of in-hospital death were age and history of stroke, while male sex, hypertension, history of MI, and invasive management were related to a lower risk of in-hospital death. One-year all-cause mortality following discharge was 38.1% (females: 38.4%, males: 37.5%; P = 0.27), the endpoint consisting of all-cause death, MI, or stroke occurred in 42.6% patients (females: 42.8%, males: 42.2%; P = 0.44), while all-cause death or cardiovascular hospitalization occurred in 59.0% (females: 58.2%, males: 60.7%; P = 0.046). Variables independently related to the higher risk of post-discharge death were age, heart failure, atrial fibrillation, diabetes, and chronic obstructive pulmonary disease. Participation in the managed care program following MI was linked to a lower risk of death or hospitalization for cardiovascular reasons. CONCLUSIONS: Variables independently related to the higher risk of post-discharge death among patients hospitalized for MI aged at least 90 years were age, heart failure, atrial fibrillation, diabetes, and chronic obstructive pulmonary disease. When managed invasively, males have lower in-hospital mortality but higher post-discharge mortality than females.
Source: Kardiologia Polska
Authors: Małgorzata Kupisz-Urbańska, Piotr Jankowski, Urszula Cegłowska, Paweł Teisseyre, Piotr Buszman, Ludmiła Daniłowicz-Szymanowicz, Agnieszka Doryńska, Jarosław Drożdż, Mariusz Gąsior, Robert Gil, Leszek Gromadziński, Miłosz Jaguszewski, Joanna Jaroch, Jarosław D Kasprzak, Monika Komar, Jacek Kubica, Przemysław Leszek, Jarosław Pinkas, Marek Rajzer, Janina Stępińska, Andrzej Surdacki, Lidia Tomkiewicz-Pająk, Roman Topór–Mądry, Piotr Waciński, Adam Witkowski, Andrzej Wysokiński, Maciej Niewada, Ryszard Gellert
Institutions: Warsaw University of Technology, Institute of Computer Science, University of Warsaw, Polish Academy of Sciences, American Heart of Poland, Andrzej Frycz Modrzewski Krakow University, Gdańsk Medical University, Medical University of Lodz, Medical University of Silesia, National Medical Institute of the Ministry of Interior and Administration, University of Warmia and Mazury in Olsztyn, Szpital im Tadeusza Marciniaka, Jagiellonian University, Nicolaus Copernicus University, Institute of Cardiology, Medical University of Lublin, Medical University of Warsaw
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4405998236