Non-ST Elevation Myocardial Infarction in Octogenarians, Nonagenarians and Centenarians: Insights from Sheba Big Data

Background: Elderly subjects (>80 years) are underrepresented in clinical trials. The current study evaluated disparities in management and outcome among elderly patients with non-ST segment myocardial infarction (NSTEMI).

Methods: Analysis included consecutive patients who were hospitalized with NSTEMI as clinical diagnosis between 06/2011 and 10/2018 at Sheba medical center.

Results: Study cohort included 5,559 patients with a median follow up of 2 (IQR 1-4) years. Mean age of the study population was 72 +/- 14 years and 3,795 (68%) were men. There were 1,892 (34%) elderly patients: 1,380 (25%) octogenarians, 492 (8.8%) nonagenarians and 20 (0.4%) centenarians. Elderly patients had higher rates of heart failure (26% vs. 11%, p<.001) atrial fibrillation (21% vs. 8%, p<.01) and kidney disease (p<0.01) and had a longer hospital stay (6 vs. 5-day, p<.001). They were less likely to be hospitalized in the cardiology department (14 % vs. 55%, p<.001), to undergo coronary angiogram during hospital stay (27% vs. 71%, p<.001) or to be prescribed new P2Y12 inhibitors following coronary intervention (13% vs. 56%, p<.001). Surprisingly, sub-analysis of all 3,114 (56%) patients who completed in-hospital coronary angiogram demonstrated similar rates of coronary intervention in both the elderly and non-elderly groups (67% for both). Kaplan Meier analysis demonstrated worse survival among elderly (p Log rank <.001; LEFT FIGURE). Multivariate cox regression consistently showed that elderly patients were 4 times more likely to die during follow up (95% CI 3.4-4.2, P<.001). Conservative treatment was associated with worse survival in the elderly (p Log rank <.001, RIGHT FIGURE).

Conclusion: Despite similar rates of coronary intervention among elderly and non-elderly patients who undergo in-hospital angiogram, elderly patients are significantly less likely to be referred for one. This discrepancy supports the need for special consideration and more clinical data in order to improve outcomes among these patients.