UC Irvine

Objectives

To determine in-hospital mortality differences in individuals with dementia and acute myocardial infarction (AMI) when using invasive coronary procedures.

Design

Retrospective cohort study.

Setting

2009 Nationwide Inpatient Sample.

Participants

Individuals admitted with a primary diagnosis of AMI (N = 631,734) to 1,045 hospitals in 44 states during 2009.

Measurements

Dementia status and procedural use of diagnostic catheterization, percutaneous intervention (PCI), and coronary artery bypass grafts (CABG) as indicated by International Classification of Diseases, Ninth Revision, codes. The primary outcome was in-hospital mortality. Using multivariable analysis adjusted for covariates, associations were made between coronary procedural use in individuals with dementia and in-hospital mortality. Additional multivariable analysis identified the association between utilization of coronary procedures and in-hospital mortality in AMI patients with dementia.

Results

Dementia diagnosis (n = 15,335) was associated with greater likelihood of in-hospital mortality (odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.15-1.29, P < .001) and less use of diagnostic catheterization (OR = 0.37, 95% CI = 0.35-0.40, P < .001), PCI (OR = 0.37, 95% CI = 0.35-0.40, P < .001), and CABG (OR = 0.19, 95% CI = 0.16-0.22, P < .001). There was less likelihood of in-hospital mortality in participants with dementia who received diagnostic catheterization (OR = 0.36, 95% CI = 0.16-0.78, P < .001), PCI (OR = 0.57, 95% CI = 0.47-0.70, P < .001), or CABG (OR = 0.22, 95% CI = 0.08-0.56, P < .001) than in those not receiving respective interventions.

Conclusion

Dementia is a significant predictor of in-hospital mortality for hospitalized individuals with AMI and is associated with less use of invasive coronary procedures. Beyond differing care patterns for individuals with AMI and dementia, these results indicate that individuals with dementia are at substantially greater risk for in-hospital mortality when they do not receive procedural interventions.