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, predominantly observed in patients with NSTEMI.
A total of 775 consecutive patients over 80 years old presenting with (N)STEMI were analyzed, divided into octogenarians (81-90 years) and nonagenarians (>90 years).
Nonagenarians demonstrated a predominance of women, lower hemoglobin levels, lower eGFR, and lower rates of coronary angiography and PCI compared to octogenarians.
No differences in clinical complication rates were found between the invasive and OMT groups.
Invasive treatment was associated with lower 1-year all-cause mortality in octo and nonagenarian (N)STEMI patients.
An invasive strategy with PCI/CABG was found to be feasible in octo and nonagenarian (N)STEMI patients and associated with improved mortality outcomes.
The number of octogenarians and nonagenarians presenting with NSTEMI is rising, yet this population remains underrepresented in clinical studies.
This research suggests that very elderly patients (those aged 80 and older) who have heart attacks can benefit from active, invasive treatment — such as procedures to open blocked arteries (PCI) or bypass surgery (CABG) — rather than medication alone. The study followed 775 patients over 80 years old who had either a STEMI (a severe type of heart attack) or NSTEMI (a less severe type) between 2020 and 2023, comparing those who received invasive procedures against those who received only optimal medical therapy. After accounting for differences between patients, those who received invasive treatment had lower rates of death at one year. The benefit of invasive treatment was most clearly seen in patients who had an NSTEMI rather than a STEMI. The study also found that the oldest patients — those over 90 — were more likely to be women, had worse kidney function and lower blood counts, and were less likely to receive invasive procedures compared to patients in their 80s. Importantly, the rate of complications was similar between those who received invasive treatment and those who received medication only, suggesting that these procedures can be safely performed even in very elderly patients. This research matters because the population of people over 80 having heart attacks is growing, yet this group has historically been left out of clinical trials. This study suggests that age alone should not prevent doctors and patients from considering invasive treatment options, and that decisions can be guided by commonly available clinical information combined with careful discussions between patients and their medical teams about goals and preferences.
Siegers C, Hoogervorst Q, Ramshorst J, Boer S, Dirksen M, Umans V. (2026). Outcomes of an Interventional Approach in STEMI and NSTEMI All-Comer Octo and Nonagenarians.. Clinical cardiology. https://doi.org/10.1002/clc.70463