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. 2024 Dec;49(6):456-463.
doi: 10.1007/s00059-024-05250-5. Epub 2024 Jun 3.

Clinical characteristics of delirium in older patients with first-ever acute myocardial infarction who underwent percutaneous coronary intervention : A retrospective study

Jin-Feng Tan  1 , Le Duan  2 , Jin-Cheng Han  1 , Jin-Jin Cui  3
Affiliations

Clinical characteristics of delirium in older patients with first-ever acute myocardial infarction who underwent percutaneous coronary intervention : A retrospective study

Jin-Feng Tan et al. Herz. 2024 Dec.

Abstract
in English, German

Objectives: Delirium is a serious complication of cardiac surgery and a common clinical problem. The study aimed to identify the incidence, risk factors, and outcomes of delirium in older patients (≥ 65 years) with first-ever acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI).

Methods: A retrospective cohort study was performed in a hospital in northern China. A total of 1033 older patients with first-ever AMI who underwent PCI between January 2018 and April 2021 were screened for delirium using the CAM-ICU method. Clinical and laboratory data were collected.

Results: A total of 134 (12.97%) patients were diagnosed with delirium. Patients with delirium were older. The most common concomitant diseases were cardiac arrest, chronic renal failure, and a history of coronary artery bypass graft (CABG). Delirious patients experienced more times of mechanical ventilation, more intra-aortic balloon pump (IABP) support, high postoperative immediate pain score (VAS), more non-bedside cardiac rehabilitation, and longer total length of stay and cardiac care unit (CCU) time. Multivariable logistic regression showed that age, mechanical ventilation, postoperative immediate pain score, and non-bedside cardiac rehabilitation were independently associated with delirium. Delirium was an independent predictor of prolonged CCU stay, total length of stay, and 1‑year mortality.

Conclusion: Age, mechanical ventilation, postoperative immediate pain score, and non-bedside cardiac rehabilitation were independently closely related to delirium in older patients with first-ever AMI who underwent PCI. Delirium was associated with a higher 1‑year all-cause mortality.

Zusammenfassung: ZIELSETZUNG: Ein Delirium ist eine ernste Komplikation der Herzchirurgie und ein häufiger klinischer Zustand. Ziel der vorliegenden Studie war, Inzidenz, Risikofaktoren und Verlauf eines Deliriums bei älteren Patienten (≥ 65 Jahre) mit erstmaligem akutem Myokardinfarkt (AMI) zu ermitteln, bei denen eine perkutane Koronarintervention (PCI) erfolgte.

Methoden: In einem Krankenhaus im nördlichen China wurde eine retrospektive Kohortenstudie durchgeführt. Dazu wurden 1033 ältere Patienten mit erstmaligem AMI und PCI in Bezug auf ein Delirium anhand der CAM-ICU(„confusion assessment method for the intensive care unit“)-Methode gescreent. Klinische und Labordaten wurden erfasst.

Ergebnisse: Ein Delirium wurde bei 134 (12,97%) Patienten diagnostiziert. Patienten mit Delirium waren älter als Patienten ohne. Als häufigste Begleiterkrankungen wurden Herzstillstand, chronische Niereninsuffizienz und ein Koronararterienbypass in der Anamnese ermittelt. Bei deliranten Patienten bestand häufiger eine mechanische Beatmung, intraaortale Ballonpumpen-Unterstützung, ein hoher unmittelbar postoperativer Schmerzscore (visuelle Analogskala [VAS]), eine ambulante kardiale Rehabilitation, längere Gesamtverweildauer und Zeit auf der kardiologischen Station. Die multivariable logistische Regression ergab, dass Alter, mechanische Beatmung, unmittelbar postoperativer Schmerzscore und ambulante kardiale Rehabilitation unabhängig mit einem Delirium verbunden waren. Ein Delirium war ein unabhängiger Prädiktor eines verlängerten Aufenthalts auf der kardiologischen Station, der Gesamtverweildauer und der Einjahresmortalität.

Schlussfolgerung: Alter, mechanische Beatmung, unmittelbar postoperativer Schmerzscore und ambulante kardiale Rehabilitation waren in unabhängiger Weise verbunden mit einem Delirium bei älteren Patienten mit erstmaligem AMI und PCI. Ein Delirium war mit einer höheren Einjahresmortalität aus sämtlichen Ursachen assoziiert.

Keywords: Acute myocardial infarction; CAM-ICU; Delirium; First-Ever.

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Conflict of interest statement

Declarations. Conflict of interest: J.-f. Tan, L. Duan, J.-c. Han and J.-j. Cui declare that they have no competing interests. For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case. This retrospective study was performed after consultation with the institutional ethics committee and in accordance with national legal requirements. The requirement for written informed consent was waived due to the retrospective character.

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