Dementia: a barrier to receiving percutaneous coronary intervention for elderly patients with ST-elevated myocardial infarction

Chanti‐Ketterl, Marianne; Pathak, Elizabeth B; Andel, Ross; Mortimer, James A.

doi:10.1002/gps.4078

Cited by 18 publications

(19 citation statements)

References 22 publications

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“…Moreover, Chanti‐Ketterl et al . reported from a further US cohort that patients 65 years of age or older with diagnosed dementia suffering STEMI were less likely to undergo PCI or CABG. As patients with dementia were significantly older and more often female within their study collective, this might confirm the potential underuse of an intervention especially in elderly female patients.…”

Section: Discussionmentioning

confidence: 99%

Gender‐related differences in elderly patients with myocardial infarction in a European Centre

Sulzgruber

Koller

Pávó

et al. 2015

Eur J Clin Investigation

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Section: Discussionmentioning

confidence: 99%

Gender‐related differences in elderly patients with myocardial infarction in a European Centre

Sulzgruber

Koller

Pávó

et al. 2015

Eur J Clin Investigation

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“…The study in Florida showed that several comorbidities were associated with use of cardiac catheterization. 19 This study also found that women, participants from lower socioeconomic strata, and those with select chronic conditions were less likely to receive a subsequent PCI after undergoing cardiac catheterization. 19 The current study also found that individuals with a history of heart failure, chronic kidney disease, or stroke were less likely to have undergone cardiac catheterization than those without these previously diagnosed comorbidities.…”

Section: Factors Associated With Not Undergoing Cardiac Catheterizationmentioning

confidence: 51%

“…19 This study also found that women, participants from lower socioeconomic strata, and those with select chronic conditions were less likely to receive a subsequent PCI after undergoing cardiac catheterization. 19 The current study also found that individuals with a history of heart failure, chronic kidney disease, or stroke were less likely to have undergone cardiac catheterization than those without these previously diagnosed comorbidities. One potential explanation for the observed sex differences in the receipt of cardiac catheterization may stem from the lower likelihood of women experiencing classic symptoms of AMI such as chest pain.…”

Section: Factors Associated With Not Undergoing Cardiac Catheterizationmentioning

confidence: 51%

“…Due to the low representation of minorities in our study population, we were unable to examine the influence of race/ethnicity as a possible predictor of notundergoing cardiac catheterization or receiving a PCI. The study in Florida showed that several comorbidities were associated with decreased utilization of cardiac catheterization 19 .This study also found that women, those from lower socioeconomic strata, and patients with select chronic conditions were less likely to have received a subsequent PCI after undergoing cardiac catheterization 19 . Our study also found that patients with a history of heart failure, chronic kidney disease, or stroke were less likely to have undergone cardiac catheterization than patients without these previously diagnosed comorbidities.…”

Section: Discussionmentioning

confidence: 70%

“…In a study examining all Florida hospital discharges between 2006 and 2007, important predictors for patients who developed an STEMI and were 75 years or older to not undergo a cardiac catheterization included being female, African-American, and having dementia 19 . Due to the low representation of minorities in our study population, we were unable to examine the influence of race/ethnicity as a possible predictor of notundergoing cardiac catheterization or receiving a PCI.…”

Section: Discussionmentioning

confidence: 99%

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Changing Trends in, and Characteristics Associated with, Not Undergoing Cardiac Catheterization in Elderly Adults Hospitalized with ST‐Segment Elevation Acute Myocardial Infarction

Tisminetzky

Erskine

Chen

et al. 2015

J American Geriatrics Society

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Objectives Little data existaboutthe magnitude and characteristics ofelderly patientswho are hospitalized foran ST-segment elevation acute myocardial infarction (STEMI)who do not undergo cardiac catheterization and/ora percutaneous coronary intervention (PCI).Our study objectives were to describe decade long trends (1999-2009)in the rates of not undergoingcardiaccatheterizationand PCI among patients>65 years old presenting with an STEMI and factors associated with not undergoing these procedures. Design Observational study. Setting Population-based study. Participants 960residents of theWorcester (MA) metropolitan area 65 years and older who were hospitalized for an STEMI in 6 biennial periods between 1999 and 2009 at all 11central MA medical centers. Measurements Analyses were conducted to examine the characteristics of patients who did not undergo cardiac catheterization overall, and further stratified into 2 age strata (65-74 years and >75 years) Results Between 1999and 2009, dramatic declines (from 59.4% to 7.5%)were observed in the proportion ofolder patients who did not undergo cardiac catheterization at all greater Worcester hospitalsThese declines were observed in patients65-74 yearsold (58.4%to6.7%) as well as in patients 75 years and older(69.4% to13.5%).The proportion of patients not receiving a PCI after undergoing a cardiac catheterization decreased from 36.6% (in 1999) to 6.5% (in 2009). Women, patients with a prior MI, those with do not resuscitate orders, and patients withvarious comorbidities were less likely to have undergone these procedures thanrespective comparison groups. Conclusion Older patients who develop an STEMI are increasingly likely to undergo cardiac catheterizationand a PCI but several high risk groups remain less likely to undergo these procedures.

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ST‐elevation myocardial infarction in nonagenarians: A nationwide analysis of trends and outcomes in the United States

Pajjuru

Thandra

Guddeti

et al. 2020

Catheter Cardiovasc Interv

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Objective To assess ST elevation myocardial infarction (STEMI) trends and outcomes in nonagenarians undergoing primary percutaneous coronary intervention (pPCI) compared to medical management. Background Although nonagenarians (age greater than 90 years) represent the fast‐growing age decade of the US population, limited evidence is available regarding trends and outcomes of treatment strategies for STEMI in this population cohort. Methods We performed a retrospective analysis using the National Inpatient Sample (NIS) database to identify nonagenarians presenting with STEMI and treated with either pPCI or medical management. In‐hospital mortality, in‐hospital complications, length of stay and in‐hospital costs were analyzed. Results Between 2010–2017, 41,042 STEMI hospitalizations were identified in nonagenarians, of which 11, 155 (27.2%) included pPCI whereas 29, 887 (72.8%) included medical management. STEMI hospitalizations among nonagenarians decreased over the study period. Overall unadjusted in‐hospital mortality was 21.6%, and the hospitalizations that included pPCI had significantly lower mortality compared to the medical management (13.6% vs. 24.5%, p < .001). After adjusting for baseline characteristics, hospitalizations that included pPCI had 42.1% lower odds of in‐hospital mortality (adjusted OR: 0.58, 95% CI: 0.50 to 0.67, p < .001). Altogether, in‐hospital cardiac, bleeding and vascular complications, length of stay and in‐hospital costs were higher in pPCI hospitalizations. Conclusion In nonagenarians, STEMI mortality is high, but pPCI is associated with superior outcomes compared to medical management alone. Therefore, pPCI can be considered an acceptable treatment strategy in this population.

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Dementia: a barrier to receiving percutaneous coronary intervention for elderly patients with ST-elevated myocardial infarction

Abstract: 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.

Cited by 18 publications

References 22 publications

Gender‐related differences in elderly patients with myocardial infarction in a European Centre

Gender‐related differences in elderly patients with myocardial infarction in a European Centre

Changing Trends in, and Characteristics Associated with, Not Undergoing Cardiac Catheterization in Elderly Adults Hospitalized with ST‐Segment Elevation Acute Myocardial Infarction

ST‐elevation myocardial infarction in nonagenarians: A nationwide analysis of trends and outcomes in the United States

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