The STEMI in the last decades of life. Are there differences in clinical practice?

Ischemic heart disease is the most common cardiovascular pathology. Its incidence increases with age, with limited representation of extreme age groups, especially in octogenarians and nonagenarians, which complicates the application of evidence in clinical practice for these age groups.

To analyse and compare cardiovascular risk factors (CVRF) and the presentation of acute myocardial infarctions with ST-segment elevation (STEMI) in the population subgroups of octogenarians and nonagenarians.

A retrospective analysis was conducted of a total of 7,205 patients admitted to the cardiology intensive care unit of our centre, of which 3,046 presented with STEMI between the years 2012-2024.

A total of 489 patients (16.5%) with STEMI were included in the octogenarian group and 69 patients (2.26%) in the nonagenarian group. The average age was 84 years ± 2.68 and 91 years ± 2.27, respectively. In both groups, the majority were male (64.8% vs. 58%). The cardiovascular risk factors and history of previous cardiovascular disease are presented in Table 1.

Regarding the event that led to admission, the most common location in both groups was anterior (35.4% vs. 31.9%), followed in the octogenarian group by inferior (19.4%) and in the nonagenarian group by inferoposterior (18.8%). In both groups, the most used access was radial (85.7% vs. 85.5%). The initial presentation, use of vasoactive drugs, complications from the infarction, and mortality in the coronary intensive care unit are summarized in Table 2. In the octogenarian group, the most common finding was single vessel involvement (47.2%), whereas in the nonagenarian group, it was evenly distributed between one or two vessels (both at 40.6%). In both groups, the most affected artery was the anterior descending artery. The left ventricular ejection fraction was 42% ± 12 in both groups. There were no statistically significant differences in the prescribed antiplatelet treatment, with aspirin and clopidogrel being the most used. A greater use of drug-eluting stents was observed in the octogenarian group (43.1% vs. 27.5%).

We observed a homogeneous distribution in the presentation forms of STEMI, with similar use of vasoactive drugs in both groups, although mechanical circulatory support and ultrafiltration were used in a small group of octogenarian patients. Furthermore, a similar number of complications were observed.

Overall, despite the disparity in sample sizes, the data suggest a similarity between both age groups, with a greater use of invasive techniques in a small group of younger patients.

Open in new tabDownload slide

Open in new tabDownload slide