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Cognitive impairment and outcomes in older adults with non-ST-elevation acute coronary syndrome
  1. Valerie Josephine Dirjayanto1,2,
  2. Mohammad Alkhalil1,3,
  3. John Dodson4,
  4. Gregory Mills1,
  5. Graziella Pompei1,5,
  6. Francesca Rubino1,6,
  7. Vijay Kunadian1,3
  1. 1 Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
  2. 2 Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
  3. 3 Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle upon Tyne, UK
  4. 4 The Leon H. Charney Division of Cardiology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
  5. 5 Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, UK
  6. 6 Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
  1. Correspondence to Professor Vijay Kunadian, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, NE2 4HH, UK; vijay.kunadian{at}


Objective This study aimed to explore the prognostic impact of cognitive impairment on the long-term risk of major adverse cardiovascular events (MACEs) in older patients with non-ST-elevation acute coronary syndrome (NSTEACS) undergoing invasive treatment.

Methods Patients aged ≥75 years with NSTEACS undergoing an invasive strategy were included in the multicentre prospective study (NCT01933581). Montreal Cognitive Assessment was used to evaluate cognitive status at baseline (scores ≥26 classified as normal, <26 as cognitive impairment). Long-term follow-up data were obtained from electronic patient care records. The primary endpoint was MACE as a composite of all-cause deaths, reinfarction, stroke/transient ischaemic attack, urgent revascularisation and significant bleeding.

Results 239 patients with baseline cognitive assessment completed long-term follow-up. Median age was 80.9 years (IQR 78.2–83.9 years) and 62.3% were male. On 5-year follow-up, there was no significant difference in the occurrence of MACE between the cognitively impaired group and the normal cognition group (p=0.155). Cognition status was not associated with MACE (HR 1.37 (95% CI 0.96 to 1.95); p=0.082). However, there was significantly more deaths (p=0.005) in those with cognitive impairment. Kaplan-Meier survival analysis (log-rank p=0.003) and Cox regression analysis (aHR 1.85 (95% CI 1.11 to 3.08); p=0.018) revealed increased risk of all-cause mortality, even after adjusting for frailty and GRACE (Global Registry of Acute Coronary Events) score.

Conclusion Cognitive impairment in older patients with NSTEACS undergoing an invasive strategy was associated with long-term all-cause mortality. Routine cognitive screening may aid risk stratification and further studies are needed to identify how this should influence management strategies and individual decision-making in this patient group.

Trial registration number NCT01933581.

  • Myocardial Infarction
  • Acute Coronary Syndrome
  • Atherosclerosis

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @fra_rubi, @VijayKunadian

  • Contributors VJD undertook data analysis, wrote the first draft and multiple revisions. VK conceived the idea and undertook multiple revisions. JD, MA, GM, GP and FR undertook critical review. VK takes overall responsibility for this manuscript.

  • 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.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.