BACKGROUND: Myocardial infarction (MI) remains the leading cause of death, especially in the elderly. AIMS: To characterize management and factors related to event-free survival in patients with acute MI aged at least 90 years. METHODS: We included all patients aged at least 90 years hospitalized for MI in Poland between 2014 and 2020 and followed them for one year. RESULTS: A total of 14 970 patients (median age 92.7 [90.9-93.8] years) were included (4666 men and 10 304 women). Coronary angiography was performed in 47.0% of patients, percutaneous coronary intervention in 39.8%, and coronary artery bypass grafting in 0.2%. In-hospital mortality was 27.8% (25.1% in men and 29.0% in women
P <
0.001). Variables independently related to the higher risk of in-hospital death were age and history of stroke, while male sex, hypertension, history of MI, and invasive management were related to a lower risk of in-hospital death. One-year all-cause mortality following discharge was 38.1% (females: 38.4%, males: 37.5%
P = 0.27), the endpoint consisting of all-cause death, MI, or stroke occurred in 42.6% patients (females: 42.8%, males: 42.2%
P = 0.44), while all-cause death or cardiovascular hospitalization occurred in 59.0% (females: 58.2%, males: 60.7%
P = 0.046). Variables independently related to the higher risk of post-discharge death were age, heart failure, atrial fibrillation, diabetes, and chronic obstructive pulmonary disease. Participation in the managed care program following MI was linked to a lower risk of death or hospitalization for cardiovascular reasons. CONCLUSIONS: Variables independently related to the higher risk of post-discharge death among patients hospitalized for MI aged at least 90 years were age, heart failure, atrial fibrillation, diabetes, and chronic obstructive pulmonary disease. When managed invasively, males have lower in-hospital mortality but higher post-discharge mortality than females.