Impact of percutaneous coronary intervention on in-hospital mortality in elderly patients with acute coronary syndrome: an age-stratified analysis

Introduction The growing proportion of very elderly patients presenting with acute coronary syndrome (ACS) raises uncertainty regarding the benefit of percutaneous coronary intervention (PCI), particularly in those aged ≥85 years, who often exhibit increased frailty and multiorgan impairment. Purpose To compare clinical characteristics, management strategies and predictors of in-hospital mortality between patients aged 75–84 years and those aged ≥85 years hospitalised with ACS, focusing on the impact of PCI. Methods We conducted a retrospective analysis of consecutive patients aged ≥75 years admitted with ACS. Patients were stratified into two groups: 75–84 years and ≥85 years. Categorical variables were analysed using χ² or Fisher’s exact test and continuous variables using Student’s t-test or Mann–Whitney U test, as appropriate. Univariate logistic regression was performed separately in each group to identify predictors of in-hospital mortality. Estimated glomerular filtration rate (eGFR) was used to assess renal function. Results PCI was performed more frequently in patients aged 75–84 years than in those aged ≥85 years (34.8% vs 17.4%, p<0.001). In-hospital mortality was similar between groups (16.2% vs 19.9%, p=0.178). Patients aged ≥85 years had lower systolic blood pressure, lower haemoglobin, higher urea, lower eGFR, lower albumin and a higher prevalence of chronic kidney disease (all p<0.05), indicating reduced physiological reserve. In patients aged 75–84 years, PCI was associated with lower in-hospital mortality (p<0.001); absence of PCI was associated with increased risk of death (odds ratio 2.678; 95% confidence interval 1.673–4.258). In contrast, PCI was not associated with mortality reduction in patients aged ≥85 years (p=0.943). In both groups, mortality was associated with higher Killip class, cardiac arrest at admission, lower systolic blood pressure, lower left ventricular ejection fraction, hyperglycaemia, elevated urea and creatinine, and lower eGFR. Conclusion Patients aged 75–84 years appear to benefit from invasive management, whereas in those aged ≥85 years short-term mortality is predominantly driven by systemic factors, and PCI does not significantly influence in-hospital outcome. These findings support age- and frailty-oriented individualised decision-making in elderly patients with ACS.