Neurological

Revascularization type is not related to changes in the rate of memory loss

In older adults undergoing coronary revascularization, the type of procedure being performed is (coronary artery bypass graft [CABG] vs percutaneous coronary intervention [PCI]) has shown no effect on the rate of memory loss, according to a study recently published in the Journal of the American College of Cardiology.

The authors of this retrospective cohort study wrote that their investigation is important because “[i]It is uncertain whether [CABG] is associated with cognitive decline in older adults compared to a non-surgical method of coronary revascularization (PCI). ”The aim of the study was to compare the change in memory loss rate after PCI with CABG.

The study included 1680 participants (41% women) of the Health and Retirement Study who underwent PCI or CABG between 1998 and 2015. The participants were ≥ 65 years old (mean age at the time of the procedure 75 years). Medicare billing records were used to determine the type of cardiac intervention. A total of 665 received CABG and 1015 were treated with PCI. In the CABG group, 168 patients underwent off-pump procedures. The primary endpoint was a composite memory score (derived from cognitive test scores and surrogate cognitive reports obtained every two years in the Health and Retirement Study) normalized to a Z-score (mean of 0). The secondary endpoint was the likelihood of developing dementia (a combination of the telephone interview on cognitive status, memory value and the series of 7 subtractions). In order to minimize the influence of atypically long data periods before or after the procedure, the modeling for these endpoints was limited to 5 years before the procedure to 10 years after the procedure. Multivariable linear mixed effects modeling was used to analyze the memory score with a further analysis of the CABG on the pump versus that outside the pump. A change in memory loss of 1 SD (0.048 memory units / year) was designated as the minimum for clinical significance.

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Those who had undergone PCI were increasing memory at an average rate of 0.064 storage units / year (95% CI, 0.052-0.078) before the procedure and 0.060 storage units / year (95% CI, 0.048-0.071) ) after the procedure. Group changes of 0.004 memory units / year (95% CI, −0.010 to 0.018). Among those who underwent CABG, the pre-procedural rate of memory loss was 0.049 memory units / year (95% CI, 0.033-0.065) and the postoperative rate was 0.059 memory units / year (95% CI, 0.047-0.072). Group change of −0.011 memory units / year (95% CI, −0.029 to 0.008). This resulted in a difference between the groups of 0.015 memory units / year (PCI vs. CABG; 95% CI, -0.008 to 0.038; P = 0.21). The rate of memory loss increased significantly after CABG outside the pump compared to PCI (0.046 storage units / year; 95% CI, 0.008-0.084; P <0.05). However, there was no statistically significant increase after on-pump CABG vs. PCI (0.003 storage units / year; 95% CI, -0.024 to 0.031).

These results are constrained by the inclusion of people in the study who are both losing weight and improving, the uncertain clinical relevance of the brief neuropsychological assessments that were included in the health and retirement study, the inclusion of only those who received a remuneration Received care, lack of data on potentially influential confounders, a focus on surgical techniques that may have evolved since the study period, and a heavy weighting of memory score in relation to memory function.

The study researchers concluded that “the type of revascularization procedure in older adults who underwent CABG or PCI coronary revascularization was not significantly associated with differences in the rate of change in memory loss.”

reference

Whitlock EL, Diaz-Ramirez LG, Smith AK et al. Association of coronary artery bypass graft vs. percutaneous coronary intervention with memory loss in older adults undergoing coronary revascularization. J. Am. Coll. Cardiol. 2021; 325 (19): 1955-1964. doi: 10.1001 / jama.2021.5150

This article originally appeared on The Cardiology Advisor

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