Factors related to one-year mortality in nonagenarians with acute myocardial infarction: a nationwide analysis

Background Myocardial infarction (MI) has been stated as a major cause of death in the elderly. The prevalence of MI and mortality of patients with MI is strongly influenced by age. Purpose To characterize factors related to one-year mortality in patients with acute myocardial infarction 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 14970 patients (mean age 92.7±2.3 years; 4666 men and 10304 women) were included. Coronary angiography was performed in 47.0% of patients, PCI in 39.8%, and CABG in 0.2% of patients. In-hospital mortality was 27.8% (25.1% in men and 29.0% in female patients; P<0.001), 23.0% in patients managed invasively and 32.1% in those managed conservatively (P<0.001). 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 in 59.0% (females: 58.2%, males: 60.7%, P=0.046). The one-year all-cause mortality (in-hospital and post-discharge deaths combined) was 54.3% (females: 56.3%, males: 53.2%, P<0.001), but sex was not related to one-year mortality after adjustment in multivariable analysis. Variables independently related to the higher risk of one-year mortality were: age per one year (HR 1.05 [CI 95% 1.04-1.06]), heart failure (1.09 [1.04-1.14]), diabetes (1.08 [HR 1.02-1.13]), and chronic obstructive pulmonary disease (HR 1.09 [1.01-1.18]). Meanwhile, hospitalisation in a department of cardiology or internal medicine respectively (0.76 [0.70-0.83]) and (0.85 [0.78-0.93]), invasive management (at least coronary angiography) (0.65 [0.62-0.69]), and hypertension (0.87 [0.82-0.92]) were linked to lower risk of one-year mortality. Conclusion Age and comorbidities, but not sex, are independent predictors of one-year mortality. Variables related to one-year mortality