Outcomes and Predictors of In-hospital Mortality in Nonagenarians with NSTEMI: A Comparison of PCI and Medical Management

Abstract

Nonagenarians, the fastest-growing U.S. age group, face a high burden of Non-ST-Elevation Myocardial Infarction (NSTEMI), yet the utilization and outcomes of percutaneous coronary intervention (PCI) in this population remain poorly understood. The aims of this study were to assess patient characteristics, comorbidities, and in-hospital outcomes in nonagenarians and identify predictors of in-hospital mortality. We analyzed 122,845 hospitalizations with a principal discharge diagnosis of NSTEMI among nonagenarians using the National Inpatient Sample (2015-2019) to compare PCI (8%) versus medical management (92%). Over the study period, there was an 18% reduction in medically managed cases (p = 0.04), while PCI utilization increased from 7% to 9% (p = 0.03). The medical management cohort had significantly higher Elixhauser comorbidity (EC) scores (p <0.001), 30-day readmission EC scores (p <0.001), in-hospital mortality EC scores (p <0.001), and in-hospital mortality rate (7.9% vs 4.2%; p <0.001). Mortality predictors differed: mortality in the medical management group was most strongly associated with alcohol abuse, chronic blood loss anemia, and diabetes; whereas mortality in the PCI group correlated most strongly with inotrope/vasopressor use, chronic pulmonary disease, prior transient ischemic attack, and peripheral vascular disease. Despite rising adoption, PCI remains underutilized in nonagenarians. PCI is linked to lower in-hospital mortality. The distinct comorbidity profiles and mortality predictors underscore the need for individualized treatment strategies in this vulnerable elderly population.