Cognitive Decline in Older Patients With Non‐ST Elevation Acute Coronary Syndrome

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Jennifer Adams‐Hall¹  Weiliang Qiu²  Dermot Neely³  Jonathan A. Batty⁴  Benjamin Beska⁴  Danny Chan⁴  Vijay Kunadian⁴  Sophie Z. Gu⁴  Helen Mossop⁵ 

[1] Cardiothoracic Centre Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK;Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA;Department of Biochemistry Newcastle upon Tyne Hospitals NHS Foundations Trust Newcastle upon Tyne UK;Institute of Cellular Medicine Newcastle University Newcastle upon Tyne United Kingdom;Institute of Health and Society Newcastle University Newcastle upon Tyne United Kingdom;

关键词: cognition;    cognitive impairment;    coronary artery disease;    non‐ST‐segment–elevation acute coronary syndrome;   

DOI  :  10.1161/JAHA.118.011218

来源: DOAJ

【 摘 要 】

Background Dementia is a growing health burden of an aging population. This study aims to evaluate the prevalence of cognitive impairment and the predictors of cognitive decline at 1 year in older patients with non‐ST–elevation acute coronary syndrome undergoing invasive care. Methods and Results Older patients with non‐ST–elevation acute coronary syndrome were recruited into the ICON1 study. Cognition was evaluated using Montreal Cognitive Assessment. The composite major adverse cardiovascular events comprised death, myocardial infarction, unplanned revascularization, stroke, and significant bleeding at 1 year. Of 298 patients, 271 had cognitive assessment at baseline, and 211 (78%) had follow‐up Montreal Cognitive Assessment at 1 year. Mean age was 80.5±4.8 years. There was a high prevalence (n=130, 48.0%) of undiagnosed cognitive impairment (Montreal Cognitive Assessment score <26) at baseline. Cognitive impairment patients were more likely to reach major adverse cardiovascular events by Kaplan–Meier analysis (P=0.047). Seventy‐four patients (35.1%) experienced cognitive decline (Montreal Cognitive Assessment score drop by ≥2 points) at 1 year. Recurrent myocardial infarction was independently associated with cognitive decline at 1 year (odds ratio 3.19, 95% confidence interval 1.18–8.63, P=0.02) after adjustment for age and sex. Conclusions In older patients undergoing invasive management of non‐ST–elevation acute coronary syndrome, there is a high prevalence of undiagnosed cognitive impairment at baseline. Recurrent myocardial infarction is independently associated with cognitive decline at 1 year. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01933581.

【 授权许可】

Unknown