Impact of coronary intervention on in-hospital mortality in octogenarians and nonagenarians, compared to elderly patients aged < 80 years with acute coronary syndromes

Background: Given that the Australian population is aging, with older patients presenting with acute coronary syndrome (ACS), its management over the past 20 years is likely to have changed. Methods: Retrospective observational study from the New South Wales statewide Admission Patient Data Collection database of those aged ≥ 65 years hospitalized for ACS between January 2002 and December 2021. Patients were stratified into 3 age groups: 65-79 years, 80-89 years, ≥ 90 years). Temporal trends of ACS, coronary angiogram (CA), and percutaneous coronary intervention (PCI) and in-hospital mortality were evaluated. Multivariable analysis was used to adjust for baseline profiles and year of admission in mortality analysis. Results: The study cohort comprised 118,608 patients (56.7% aged 65-79 years [n = 67,211]; 34.1% aged 80-89 years [n = 40,452]; 9.2% aged ≥ 90 years [n = 10,945]). Those aged 65-79 years, compared to older groups, had proportionally more male patients, with higher rates of ischemic heart disease, diabetes, smoking history, prior PCI and/or surgical bypass revascularization, and obesity. Heart failure, chronic pulmonary and renal disease, and dementia were more common in the older age groups. Proportionally, ST-elevation myocardial infarction decreased over time, whereas non-ST-elevation myocardial infarction rates increased. Although fewer CAs were performed in the older age groups, PCI rates in those who had CA were higher in those aged ≥ 80 years. Multivariable analysis showed that in-hospital mortality fell 49% in the group admitted in 2017 or later, vs in 2006 or earlier; for the younger, vs the older age groups, mortality fell by 55.4%, 52.5%, and 44.6%, respectively. The group aged ≥ 90 years had 3.1-fold higher adjusted odds of in-hospital death, compared to the group aged 65-79 years. Conclusions: Over the past 2 decades, with increasing rates of coronary intervention, rates of in-hospital mortality in the elderly decreased, but older patients continue to have poorer outcomes following ACS.