Nonagenarians represent fastest-growing U.S. demographic. They face high NSTEMI burden. PCI utilization and outcomes remain unclear in this group. In the study published in the American Journal of Cardiology, the researchers analyzed 122,845 NSTEMI hospitalizations from 2015-2019. Data came from National Inpatient Sample. They compared PCI (8% of cases) versus medical management (92%). Medical management cases dropped 18% over study period (p=0.04). PCI use rose from 7% to 9% (p=0.03).
Medical Management Carries Higher Comorbidity Burden
Medical management patients had higher Elixhauser comorbidity scores (p<0.001). They showed higher 30-day readmission scores (p<0.001). In-hospital mortality scores were also higher (p<0.001). In-hospital mortality reached 7.9% versus 4.2% for PCI (p<0.001).
Mortality Predictors Differ by Treatment Strategy
Medical management mortality linked most to alcohol abuse. Chronic blood loss anemia strongly predicted death. Diabetes also associated with higher risk in this group. PCI mortality correlated with inotrope/vasopressor use. Chronic pulmonary disease increased PCI mortality risk. Prior transient ischemic attack predicted worse PCI outcomes. Peripheral vascular disease showed strongest PCI mortality association.
Individualized Approach Essential for Nonagenarians
PCI demonstrates lower in-hospital mortality benefit. Utilization remains under 10% nationally. Distinct comorbidity profiles exist between treatment groups. Mortality predictors vary significantly by strategy. Cardiologists need individualized risk assessment for nonagenarians. Age alone should not preclude PCI consideration. Heart team discussions optimize revascularization decisions. Frailty and comorbidity burden guide therapy selection over chronologic age alone. Rising PCI adoption reflects evolving evidence supporting invasive strategy even among vulnerable elderly.