Background There is very little clinical data or specific management guidelines for very elderly patients with STEMI. We evaluated our practice in the management of STEMI in patients over age 85. This was a retrospective study of STEMI patients aged >85 in a PPCI (Primary percutaneous coronary intervention) centre over an 18 month period.

Methods and Results Data was collected from local and MINAP database. Of the 993 patients,6.6% were >85 years of age. There were 38 males (average age 88 years (85–96). 63% had PPCI and 27% were treated medically. Inferior MI (50%) was more common than Anterior (36%). Patients had multiple co-morbidities. 77% were discharged alive and 23% died in hospital and a further 16% died 1 year post-discharge. In –hospital complication rate was 13%. Of 31 managed conservatively, 67% were females. Presentation was generally atypical. PPCI was not offered due to late presentation(32%),cardiogenic shock, high risk of bleeding, resolution of symptoms and frailty. 64% were discharged alive, 22% died in the hospital and 4 transferred to a different hospital. Additional 25% died 1 year post-discharge. Complication rate was 12%. In the PPCI group (35), 24 (68%) male patients, average age 87 years presented with typical symptoms.85% of patients were discharged alive and a further 8.5% died within 1 year post-discharge. Complication rate was 14%. Elderly patients undergoing PPCI had better outcomes despite multiple co-morbidities.

Conclusion Therefore, PPCI has a role in the treating the very elderly with STEMI, this analysis emphasises the need for clinical trials targeted at this population.