Outcomes of an Interventional Approach in STEMI and NSTEMI All‐Comer Octo and Nonagenarians

Q: What are the key findings of this study?

An invasive strategy was associated with significantly lower 1-year all-cause mortality compared to optimal medical therapy in octogenarian and nonagenarian patients with NSTEMI (adjusted HR 0.430, p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: STEMI and NSTEMI (n=775). Intervention: Invasive strategy (PCI or CABG) vs. Optimal medical therapy. Primary outcome: All-cause mortality at 365 days (NSTEMI subgroup) (Adjusted HR 0.430, 95% CI 0.315-0.585, p=<0.001).

Q: What does this research mean for the field?

An initial invasive strategy is associated with lower 1-year mortality compared with optimal medical therapy in octogenarians and nonagenarians presenting with acute myocardial infarction, with the benefit predominantly observed in NSTEMI. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To describe patient characteristics and compare all-cause mortality between an initial invasive strategy and optimal medical treatment in octogenarians and nonagenarians presenting with STEMI and NSTEMI.

Charlotte E. P. Siegers; Quinten P. Hoogervorst; Jan van Ramshorst; Sanneke P.M. de Boer; Maurits Theodoor Dirksen; Victor A.W.M. Umans

doi:10.1002/clc.70463

September 1, 2026Clinical CardiologyOpen Access

Outcomes of an Interventional Approach in STEMI and NSTEMI All‐Comer Octo and Nonagenarians

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Key result

Invasive strategy is associated with ~57% lower 1-year mortality versus OMT in very elderly NSTEMI.

Adjusted HR 0.430
95% CI 0.315-0.585
P<0.001
n=775

Figures

Graphical abstract published by Clinical Cardiology — Graphical abstract · Published by Clinical Cardiology · CC BY

Why the study?

Octogenarians and nonagenarians with (N)STEMI are underrepresented in studies, and the impact of an initial invasive strategy versus optimal medical treatment on mortality is unclear.

Does an invasive strategy reduce all-cause mortality in octogenarian and nonagenarian patients with (N)STEMI compared to optimal medical therapy?

Key Points

To describe patient characteristics and compare all-cause mortality between an initial invasive strategy and optimal medical treatment in octogenarians and nonagenarians presenting with STEMI and NSTEMI.
Conducted a single-cohort study of 775 consecutive (N)STEMI patients aged > 80 years (81 aged > 90 years) admitted between 2020 and 2023.
Compared invasive management (coronary angiography with PCI or CABG) versus optimal medical therapy (OMT) across two age groups (80–89 years vs. ≥ 90 years).
Evaluated outcomes over a median follow-up of 999 days (IQR 602–1420) using multivariable regression adjusting for comorbidities, frailty markers, and presentation type.
Mortality at 365 days was 17% in patients aged 80–89 years compared with 39% in those aged ≥ 90 years, with higher adjusted odds of 1-year death among nonagenarians (adjusted OR 2.26, 95% CI 1.28–3.99; p = 0.005).
Clinical complication rates did not differ between treatment groups, including in-hospital BARC type 3a bleeding (p = 0.55 in STEMI, p = 0.78 in NSTEMI) and stroke (p = 0.62 in NSTEMI).

Study Design

Type

Cohort (n=775)

Multicenter

No

Structured PICO

Does an invasive strategy reduce all-cause mortality in octogenarian and nonagenarian patients with (N)STEMI compared to optimal medical therapy?

P

Population

775 consecutive patients aged 80 years and older with STEMI or NSTEMI, followed for a median of 999 days to compare invasive strategy versus optimal medical therapy.

E

Exposure

Invasive strategy (coronary angiography followed by PCI or CABG if indicated)

C

Comparator

Optimal medical therapy (OMT) without revascularization

O

Outcome

All-cause mortality at 365 dayshard clinical

Main Result

Hazard Ratio: 0.43 (95% CI 0.315–0.585)

Absolute Event Rate: 8.5% vs 28.8%

p-value: p=<0.001

Invasive management of (N)STEMI in patients aged ≥80 years is feasible and associated with improved survival, particularly in NSTEMI, supporting a tailored invasive approach in the very elderly.

Limitations

Observational design with potential residual confounding and selection bias
Clinical characteristics derived from physician-reported EHR data subject to misclassification
Lack of data on ejection fraction or peripheral arterial disease
Observational design cannot exclude residual confounding and selection bias
Clinical characteristics derived from EHR data subject to misclassification

Implication

May support invasive strategy in selected very elderly NSTEMI patients; leaves open need for randomized confirmation.

Abstract

INTRODUCTION: The number of octogenarians and nonagenarians presenting with (NSTEMI) is rising. However, they are underrepresented in studies. Therefore, we aim to clarify patient characteristics and compare all-cause mortality of an initial invasive strategy versus optimal medical treatment in (N)STEMI octo and nonagenarians. METHODS: All consecutive patients with (N)STEMI admitted from 2020 until 2023 were included. Patients were divided into invasive and OMT groups. Multi-variation corrected analyses were performed in two age groups. RESULTS: 775 consecutive patients > 80 years old were analyzed (81 > 90 years). A predominance of women, lower hemoglobin levels, eGFR, and lower rates of coronary angiography and PCI were observed in the nonagenarians. Six patients underwent CABG; all were in the 80-90-year age group. No differences existed in clinical complication rates between the groups. Invasive treatment demonstrated lower 1 year mortality, predominantly seen in NSTEMI elderly patients. CONCLUSION: In octo and nonagenarian (N)STEMI patients, stratifying to an invasive strategy with PCI/CABG appears to be feasible and is associated with improved mortality outcomes. This benefit is predominantly observed in patients with NSTEMI. Stratification can be done immediately on common clinical variables and appropriate shared decision-making.

Discussion

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Cite This Study

Siegers et al. (2026) conducted a cohort in STEMI and NSTEMI (n=775). Invasive strategy (PCI or CABG) vs. Optimal medical therapy was evaluated on All-cause mortality at 365 days (NSTEMI subgroup) (Adjusted HR 0.430, 95% CI 0.315-0.585, p=<0.001). An invasive strategy was associated with significantly lower 1-year all-cause mortality compared to optimal medical therapy in octogenarian and nonagenarian patients with NSTEMI (adjusted HR 0.430, p<0.001).

synapsesocial.com/papers/6ac48d42d60aa66ad775c371 https://doi.org/10.1002/clc.70463

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Outcomes of an Interventional Approach in STEMI and NSTEMI All‐Comer Octo and Nonagenarians

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Outcomes of an Interventional Approach in STEMI and NSTEMI All‐Comer Octo and Nonagenarians

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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