Impact of left anterior descending lesions on 30-day mortality in very elderly STEMI patients: insights from a multicenter registry.

AIMS: ST-elevation myocardial infarction (STEMI) in very elderly patients (≥85 years) poses a major clinical challenge due to frailty and comorbidities. In the general population, left anterior descending (LAD) artery involvement predicts adverse outcomes, but data in the very elderly are limited. We aimed to evaluate the impact of LAD culprit lesions on 30-day mortality in this population.

METHODS

In this multicenter registry (six Italian Hub hospitals, 2010-2023), 586 consecutive STEMI patients aged ≥85 years undergoing coronary angiography and percutaneous coronary intervention (PCI) were retrospectively analyzed. Patients were stratified by culprit vessel: LAD (n = 288) vs. non-LAD (n = 298). Demographic, clinical, procedural characteristics, and 30-day outcomes, including mortality and major adverse cardiovascular events, were collected. Multivariable analysis identified independent predictors of mortality.

RESULTS

Baseline differences included prior myocardial infarction (MI) (9.4% vs. 18.5%, P < 0.01), prior CABG (0.3% vs. 4.7%, P < 0.01), and dyslipidemia (35.4% vs. 45.6%, P = 0.02), less frequent in LAD STEMI. Single-vessel disease was more common in LAD STEMI (42.0% vs. 31.5%, P = 0.01). Overall, 30-day mortality was 19.3% (113/586), higher in the LAD group [hazard ratio (HR) 1.57; 95% confidence interval (CI) 1.06-2.33; P = 0.024]. In LAD STEMI, cardiogenic shock at presentation was the strongest independent predictor of death (HR 6.10; 95% CI 3.70-10.35; P = 0.01), while dyslipidemia was associated with lower mortality (HR 0.51; 95% CI 0.28-0.92; P = 0.03).

CONCLUSIONS

In very elderly STEMI patients, LAD culprit lesions are associated with higher short-term mortality. Cardiogenic shock at presentation and absence of dyslipidemia identify a high-risk subgroup, emphasizing the need for tailored risk stratification and careful procedural planning in this vulnerable population.