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Dementia: a barrier to receiving percutaneous coronary intervention for elderly patients with ST‐elevated myocardial infarction
Author(s) -
ChantiKetterl Marianne,
Pathak Elizabeth Barnett,
Andel Ross,
Mortimer James A.
Publication year - 2014
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.4078
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , dementia , cardiac catheterization , myocardial infarction , cardiology , cohort , disease
Objective Percutaneous coronary intervention (PCI) is the first line of treatment for ST‐elevated myocardial infarction (STEMI). This study evaluates the role of dementia in diagnostic cardiac catheterization (to receive PCI) in STEMI patients ≥65 years old admitted to high annual volume PCI hospitals. Methods Participants were registered in Florida's comprehensive inpatient surveillance system for the years 2006–2007 with principal diagnosis of STEMI. Dementia was defined using ICD‐9 codes for presenile, senile, and Alzheimer's type dementia. Results Data from 8331 STEMI patients were used. Of these, 77.2% were catheterized, 67.2% received PCI, and 9.3% had coronary artery bypass graft (CABG). The mean age of the cohort was 76.3 years (SD 7.8 years.); with 43.3% female, 83.4% white, 4.6% black, and 12% Hispanic/other. Of the 248 (3%) patients with dementia, 42% were catheterized. After adjustment for age, gender, and race/ethnicity, patients with dementia were less likely to be catheterized (RR 0.30, 95% CI 0.30‐0.50) than non‐demented patients. However, among patients who were catheterized, there was no difference in the use of PCI or CABG for patients with versus without dementia ( p = 0.56). Of those with dementia, being older and arriving to the hospital in the afternoon were associated with lower likelihood of being catheterized (RR 0.08, 95% CI 0.02‐0.28, and RR 0.30, 95% CI 0.10‐0.88, respectively). However, having hyperlipidemia increased the probability of catheterization (RR 3.60, 95% CI 1.86‐6.98). Conclusion ST‐elevated myocardial infarction patients with dementia were much less likely to receive diagnostic cardiac catheterization, thereby limiting the possibility for receiving optimal care including PCI or CABG. Copyright © 2014 John Wiley & Sons, Ltd.