P3492Nonagenarians with acute myocardial infarction; invasive versus conservative strategy

Background: There is limited data supporting invasive strategy in nonagenarians with acute myocardial infarction (AMI). We aimed to investigate performing percutaneous coronary intervention (PCI) is beneficial in these frail population. Methods: We retrospectively analyzed 41 nonagenarians with AMI (both ST-segment elevation MI and non-ST segment MI) between 2006 and 2015 in single center. We assessed 30-day and 1-year mortality according to treatment strategy. Results: Among study subjects, 24 (59%) were treated with PCI (PCI group) and 17 (41%) with conservative management (conservative group) upon clinician's discretion. Median follow-up duration was 30 months (0 to 74). Age, sex, smoking, diabetes, dyslipidemia, history of coronary artery disease were not different significantly between the two groups. Body mass index (BMI) was significantly higher in PCI group (21.19 versus 18.97, P<0.05). Thirty-day mortality was lower in PCI group than in conservative group (17% versus 65%, respectively, P<0.001). One-year mortality was also lower in PCI group than in conservative group (21% versus 76%, respectively,P<0.001). Cox proportional hazard regression analysis was performed to adjust the effect of age, sex, BMI, ejection fraction, renal insufficiency and killip class on death. Conservative group had about 6 times higher risk of death (adjusted HR: 6.36, 95% CI: 2.19–18.47, P<0.001). In subgroup with Killip class 1–3 (36), 30-day and 1-year mortality were still higher in conservative group (13% versus 54% in 30-day, P<0.001; 17% versus 69% in 1-year, p<0.001). In subgroup of 30-day survivors, there was no significant difference in cumurative mortality rate between the two groups, indicating that mortality difference was mainly decided within the first 30 days after AMI.