Objective We investigated whether mental status assessed by simple bedside tests in elderly patients admitted for acute coronary syndromes (ACS) was associated with higher risk of mortality.
Methods We used the data from a prospective, open, ongoing cohort of patients≥75 years old admitted for ACS to a tertiary centre. Cognitive impairment (CogI) was defined by delirium detected by the Confusion Assessment Method or an abnormal Mini Mental State Examination score. A Cox model adjusted on predefined correlates of mortality was used to assess the relationship between CogI and 1-year mortality.
Results Six-hundred consecutive patients with mental status assessment within 48 hours after admission were included. CogI was identified in 172 (29%) patients among whom 153 (25.5%) had an abnormal Mini Mental State Evaluation and 19 (3.2%) delirium. Death occurred in 49 (28.6%) patients with and 43 (10.5%) patients without CogI at 1 year. There was a significant association between CogI and 1-year mortality (adjusted-HR 2.4, 95% CI 1.53 to 3.62), p<0.001) independent of other covariables. CogI was also independently associated with higher rates of in-hospital bleeding and mortality as well as 3-month rates of all-cause, cardiovascular-related and heart failure-related rehospitalisation.
Conclusions CogI detected by simple bedside tests in patients≥75 admitted for ACS is associated with an increased risk of 1-year mortality and 3 month rehospitalisation independent of other correlates of poor outcome.
- acute coronary syndrome
- cognitive impairment
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Contributors Study concept and design: FB, CB, VR. Analysis and interpretation of data; drafting of the manuscript; statistical analysis: CB, FB. Critical revision of the manuscript for important intellectual content: KB, AL, IR, KL, AR, MB, PA, RS.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The funders have no role in the design or conduct of the study; the collection, analysis and interpretation of data or the preparation, review or approval of the manuscript.
Competing interests Thelogistics and management of our cohorts are supported by grants from Biosensors, Medtronic and Boston Scientific.
Ethics approval The inclusion of patients in the cohort and the use of patient’s clinical data and follow-up for research purposes has been approved by the French North-West-3 ethics board. All patients gave informed consent to be included in the cohort.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.