Temporal trends and outcomes of superelderly patients undergoing coronary intervention with and without acute myocardial infarction: Insights from the Japanese nationwide registry

Background Percutaneous coronary intervention (PCI) has been established as a widely available procedure for managing patients with and without acute myocardial infarction (AMI). While age is a strong predictor of outcomes after PCI, contemporary data in patients with very advanced age are limited. Purpose To delineate the current practice patterns and clinical outcomes of PCI, with a specific focus on septuagenarians, octogenarians, and nonagenarians with AMI and non-AMI in Japan, a country at the forefront of the global aging crisis. Methods The Japanese PCI (J-PCI) is a nationwide registry covering most of the PCI procedures performed within the country. PCI procedures between 2019 and2024 were included. Patients were divided into four age categories: 20–69, 70–79, 80–89, and 90–99 years, and further grouped according to the indications (AMI versus non-AMI). The trends and patterns of PCI procedures, in-hospital mortality, and complications across the age groups were assessed. Results A total of 1,454,940 PCI procedures, with 387,454 (26.6%) and 1,067,486 (73.4%) for AMI and non-AMI, were analyzed. During the study period, the mean age has consistently increased from 71.0 to 72.1 years in the entire study population. Nonagenarians accounted for 3.9% and 1.7% in the AMI and non-AMI cohorts in 2019 and 5.0% and 2.4% in 2024. In both cohorts, the higher age categories were associated with increased risks of in-hospital mortality and complications (Figure). Conclusions Our nationwide study demonstrated a consistent year-on-year increase in the age of patients undergoing PCI, despite a modest annual increase of 0.2–0.3 years, without reaching a plateau. Advanced age was strongly associated with poor outcomes, particularly in nonagenarians, reinforcing the need for shared decision-making in PCI in the oldest-old population.