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

Abstract

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.

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

Figure 1

Flow diagram of ICON‐1 screening, recruitment, and cognition subgroup analysis. ACS indicates acute coronary syndrome; GP, general practitioner; ICON‐1, Study to Improve Cardiovascular Outcomes in High Risk Patients With Acute Coronary Syndrome.

Figure 2

Kaplan–Meier plot, demonstrating time to first MACE stratified by baseline cognitive status. Log‐rank test for equality of survival distributions demonstrates a significant difference between the survival curves (χ²=3.96, 1 degree of freedom, P=0.047). MACE indicates major adverse cardiovascular events (death, nonfatal myocardial infarction, urgent revascularization, stroke, and significant bleeding).

Figure 3

A, Histogram of the change in MoCA score from baseline to follow‐up. B, Parallel boxplots of the overall change in mean MoCA score at 1 year from baseline split by baseline cognition. MoCA indicates Montreal Cognitive Assessment.