Nonagenarians with ST-elevation myocardial infarction (STEMI) represent a unique and growing population and are underrepresented in clinical trials due to arbitrary exclusion criteria. Therefore, a thorough examination of STEMI in this age population may better inform management decisions.

This is a cohort study examining the Midwest STEMI Consortium database from March 2003 through October 2020. All patients with STEMI, presenting within 24 hours of symptom onset, were enrolled -including those with advanced age, cardiogenic shock, or out-of-hospital cardiac arrest. Data are described across age groups: <70, 70-79, 80-89, and ≥90 years. Main outcome measures were discharge disposition; mortality in-hospital, 30-days, and 1-year.

Among 15,039 consecutive STEMI patients, 303 (2%) were ≥90 years, of whom 194 (64%) were females. Among nonagenarians, mortality was 17% in the hospital, 20% at 30-day, and 33% at 1-year; and those living in a skilled nursing facility (SNF) before presentation had significantly higher in-hospital mortality (36%) versus those living at home or in an assisted living facility (ALF) (14% and 15% respectively). The mortality at 1 year was 13% for patients discharged to home, 20% for those discharged with home health care or ALF, and 43% for those discharged to SNF (P < .001).

In this large multicenter prospective STEMI database, nonagenarians living in SNF before presentation had more than 2-fold higher in-hospital mortality than those living at home. Furthermore, patients discharged to SNF had a 3-fold higher 1-year mortality than those discharged to home. In this older STEMI population, living status before the presentation and at hospital discharge carries important prognostic information.