Neither CABG nor PCI impact post-procedure cognitive decline risk: JAMA
USA: The type of revascularization procedure (CABG or PCI) did not impact the rate of memory decline in older adults undergoing coronary revascularization, according to a recent study in the journal JAMA.
Patients undergoing coronary revascularization are at increased risk of cognitive impairment after the procedure. It is not known whether coronary artery bypass grafting (CABG) is associated with cognitive decline in older adults compared with nonsurgical percutaneous coronary intervention (PCI). To fill this knowledge gap, Elizabeth L. Whitlock, Department of Anesthesia & Perioperative Care, University of California, San Francisco, and colleagues aimed to compare the change in the rate of memory decline after CABG vs PCI.
For this purpose, the researchers conducted a retrospective cohort study of community-dwelling participants in the Health and Retirement Study, who underwent CABG or PCI between 1998 and 2015 at age 65 years or older.
A total of 1680 patients were included; 497 had on-pump CABG, 168 had off-pump CABG, and 1015 had PCI, ascertained from Medicare fee-for-service billing records.
The primary outcome was a summary measure of cognitive tests scores and proxy cognition reports performed every 2 years in the HRS, called the memory score, which compared HRS cognitive questionnaire items against Aging, Demographics, and Memory Study samples of HRS participants.
Key findings of the study include:
- Of 1680 participants, 665 underwent CABG (168 off pump) and 1015 underwent PCI.
- In the PCI group, the mean rate of memory decline was 0.064 memory units/y before the procedure and 0.060 memory units/y after the procedure (within-group change, 0.004 memory unit).
- In the CABG group, the mean rate of memory decline was 0.049 memory units/y before the procedure and 0.059 memory units/y after the procedure (within-group change, −0.011 memory units/y).
- The between-group difference-in-differences estimate for memory decline for PCI vs CABG was 0.015 memory units/y.
- There was statistically significant increase in the rate of memory decline after off-pump CABG compared with after PCI (difference-in-differences: mean increase in the rate of decline of 0.046 memory units/y after off-pump CABG), but not after on-pump CABG compared with PCI (difference-in-differences: mean slowing of decline of 0.003 memory units/y after on-pump CABG).
"Among older adults undergoing coronary revascularization with CABG or PCI, the type of revascularization procedure was not significantly associated with differences in the change of rate of memory decline," concluded the authors.
Reference:
The study titled, "Association of Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention With Memory Decline in Older Adults Undergoing Coronary Revascularization," is published in the journal JAMA.
DOI: https://jamanetwork.com/journals/jama/article-abstract/2779992
