Pajjuru VS, Thandra A, Guddeti RR, et al. - Findings demonstrate high ST elevation myocardial infarction (STEMI) mortality as well as an association of primary percutaneous coronary intervention (pPCI) with superior outcomes than medical management alone among nonagenarians (age greater than 90 years). Thus, pPCI can afford an acceptable treatment option in this population.

• From the National Inpatient Sample database, data from nonagenarians presenting with STEMI and managed with either pPCI or medical management were retrospectively analyzed.

• There were 41,042 STEMI hospitalizations between 2010–2017; 155 (27.2%) included pPCI whereas 29, 887 (72.8%) included medical management.

• A decline in STEMI hospitalizations in nonagenarians was evident over the study period.

• Estimated overall unadjusted in-hospital mortality was 21.6%, and significantly lower mortality was observed for hospitalizations that included pPCI vs medical management (13.6% vs 24.5%).

• Post-adjusting for baseline features, a 42.1% lower odds of in-hospital death was noted for hospitalizations that included pPCI (adjusted OR: 0.58).

• In pPCI hospitalizations, higher in-hospital cardiac, bleeding and vascular complications, higher length of stay as well as in-hospital costs were recorded.