Hemorrhagic stroke, not age, SII, or TyG, is associated with mortality in oldest-old males with CHD and T2DM

BACKGROUND: Risk stratification in oldest-old (≥80 years) patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) is challenging because traditional predictors may lose prognostic value. We aimed to identify independent predictors of all-cause mortality in this population, focusing on age, the systemic immune-inflammation index (SII), and the triglyceride-glucose (TyG) index. METHODS: This single-centre retrospective cohort study included 379 male inpatients aged ≥80 years with documented CHD and T2DM. A substantial proportion of patients were admitted with acute decompensated heart failure or acute coronary syndrome, reflecting the high-acuity nature of this cohort. Baseline characteristics, age tertiles, SII, TyG, comorbidities, and medications were collected. Univariable and multivariable Cox regression were used to identify predictors of all-cause mortality. The proportional hazards assumption was tested, and a stratified Cox model was performed as a sensitivity analysis. RESULTS: During a median follow-up of 168.5 days, 325 (85.8%) patients died. In the fully adjusted multivariable model, a history of hemorrhagic stroke was the strongest independent predictor of all-cause mortality (HR = 2.53, 95% CI: 1.55-4.13, p < 0.001). eGFR showed a marginal association (HR = 0.99, 95% CI: 0.98-1.00, p = 0.048) with a very small effect size, while age (HR = 1.03, p = 0.104), heart failure, chronic kidney disease, and HbA1c were not significant. CONCLUSIONS: In this hospitalised, high-acuity cohort of oldest-old male patients with CHD and T2DM receiving standardized therapy, conventional risk factors - including age, glycaemic control, and inflammatory/metabolic indices did not show independent prognostic value in this cohort. A prior history of hemorrhagic stroke emerges as a robust independent predictor of all-cause mortality. Our findings highlight a strong association between prior hemorrhagic stroke and mortality in this hospitalised oldest-old population. Further studies are needed to determine whether targeted stroke prevention strategies improve outcomes in this population.