Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(3), 279–286. https://doi.org/10.1002/clc.23967 Dr. Afek Kodesh et al.
Points
- Dementia is an independent risk factor for worse outcomes in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).
- A study analyzing data from 9,167 patients who underwent PCI for AMI revealed that those with dementia had higher rates of death (25.5% vs. 9.8%) and major adverse cardiac events (33.8% vs. 17.6%) at the 12-month follow-up.
- After adjusting for confounding variables, dementia remained a significant independent predictor of increased risk for death (hazard ratio [HR] 1.90) and major adverse cardiac events (HR 1.73).
- Propensity score-matched analysis further confirmed the association between dementia and worse outcomes, with dementia patients having higher risks of death (HR 1.54) and major adverse cardiac events (HR 1.49).
- The findings emphasize the need for interventions and specialized healthcare measures to address the heightened risk associated with dementia in patients undergoing PCI for AMI, intending to improve outcomes and tailor treatment strategies for this vulnerable patient population.
Summary
The association between age, frailty, and poor prognosis in patients undergoing percutaneous coronary intervention (PCI) is well-established. However, the influence of dementia as an independent factor remains largely unexplored. This study assessed the relationship between dementia and outcomes in patients with acute myocardial infarction (AMI) who underwent PCI. The researchers evaluated one-year outcomes by examining data from a comprehensive AMI registry, including mortality and major adverse cardiac events (MACE). They employed Cox regression to account for potential confounding factors.
Of 28,274 patients, 9,167 individuals who underwent PCI for AMI were included in this analysis. Among them, 250 patients had a diagnosis of dementia. Patients with dementia were older (mean age 77.4±9.4) compared to the control group (mean age 63.6±12.7) and had a higher prevalence of female gender, diabetes mellitus, and chronic kidney disease. Unadjusted data showed significantly higher rates of mortality (25.5% vs. 9.8%) and MACE (33.8% vs. 17.6%) at the 12-month follow-up for patients with dementia. After adjusting for confounding variables, dementia remained an independent risk factor for death (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.37-2.65) and MACE (HR 1.73, 95% CI 1.30-2.31), as confirmed by propensity score-matched analysis (HR 1.54, 95% CI 1.03-2.28 and HR 1.49, 95% CI 1.09-2.02, respectively).
This study proves that dementia independently predicts worse outcomes in patients undergoing PCI for AMI. The findings highlight the need for future interventions and specialized healthcare measures to mitigate the heightened risk associated with dementia. Recognizing dementia as a significant prognostic factor in this patient population has important implications for personalized treatment strategies, improved patient care, and informed decision-making regarding managing individuals with AMI and concomitant dementia. Further research is warranted to elucidate this association’s mechanisms and develop tailored interventions to optimize outcomes for this vulnerable patient population.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.23967
References Kodesh, A., Bental, T., Vaknin‐Assa, H., Talmor‐Barkan, Y., Codner, P., Levi, A., Kornowski, R., & Perl, L. (2023). The independent impact of dementia in patients undergoing percutaneous coronary intervention for acute myocardial infarction. Clinical Cardiology, 46(3), 279–286. https://doi.org/10.1002/clc.23967
