Percutaneous coronary intervention in nonagenarians with acute myocardial infarction: a 15-year population-based study

The use of percutaneous coronary intervention (PCI) in very elderly patients (> 90 years) with acute myocardial infarction (AMI) remains debated due to limited evidence and the presence of multimorbidity. This study evaluated the impact of PCI using data from the Lombardy Health Database (Italy) for AMI patients hospitalized between 2003 and 2018. Among 15,954 patients (median age 92; 71% female; 50% with ST-elevation myocardial infarction [STEMI]), 12% underwent PCI. In-hospital mortality was lower in PCI-treated patients (15% vs. 23%; P < 0.0001). Overall, one-year mortality (56%) and rehospitalization for acute heart failure (AHF) or AMI (19%) were also reduced among PCI patients (37% vs. 58% and 16% vs. 21%, respectively; P < 0.0001). These findings were consistent across both STEMI and non-ST-elevation myocardial infarction (NSTEMI) subgroups and were independent of comorbidities. Adjusted risk analyses and propensity score matching (1,950 patients per group) confirmed these benefits. The use of PCI increased significantly from 4% in 2003 to 22% in 2018, while in-hospital mortality declined from 22 to 19% (from 28 to 15% in the propensity-matched cohort). In conclusion, PCI was associated with significantly lower in-hospital and one-year mortality, as well as reduced rehospitalization rates, in AMI patients older than 90 years, regardless of comorbidities.