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Published on: May 28, 2019
Delirium after primary percutaneous coronary intervention in aged individuals with acute ST-segment elevation
Sheng Li1, Xiao-Hong Zhang1, Gen-Dong Zhou1
1Department of Cardiology, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230061, P.R. China.
Insights
Delirium affects nearly 30% of older adults after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Key risk factors include advanced age, living alone, alcohol abuse history, longer PCI duration, and post-operative pain.
Area of Science:
- Cardiology
- Geriatrics
- Neuroscience
Background:
- Delirium is a significant concern in older adults undergoing cardiovascular procedures.
- Acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) are a vulnerable population.
- Understanding delirium incidence and risk factors post-PCI is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of delirium in elderly patients following primary PCI for STEMI.
- To identify independent risk factors associated with the development of post-PCI delirium in this cohort.
- To assess the impact of delirium on hospital stay, readmission rates, and long-term mortality.
Main Methods:
- Prospective study including 111 patients aged 65 years or older with acute STEMI undergoing primary PCI.
- Neurocognitive function assessed using Mini-mental State Examination on day one.
- Delirium assessed using Confusion Assessment Method for the Intensive Care Unit within four days post-procedure.
Main Results:
- Delirium developed in 32 patients (28.8%) after primary PCI.
- Independent predictors of delirium included older age (≥65 years), living alone, history of alcohol abuse, longer PCI duration, and current post-operative pain.
- Delirium was associated with longer hospital stays and higher 30-day readmission rates; one-year mortality was similar between groups.
Conclusions:
- Older patients (≥65 years) with acute STEMI face a substantial risk of delirium after primary PCI.
- Identified risk factors—advanced age, social isolation, alcohol abuse, prolonged PCI, and pain—warrant targeted preventive strategies.
- Delirium negatively impacts short-term outcomes, emphasizing the need for early detection and management in this population.
Abstract:
The present prospective study aimed to investigate the incidence and risk factors of delirium after primary percutaneous coronary intervention (PCI) in older adults with acute ST-segment elevation myocardial infarction (STEMI). A total of 111 patients (age, ≥65 years) with acute STEMI following primary PCI were included in the present study. Neurocognitive testing was performed using the Mini-mental State Examination on the first day of hospitalization. Post-operative delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit within the first four post-operative days. A total of 32 patients (28.8%) developed delirium after primary PCI. The independent predictors of delirium were older age [odds ratio (OR)=1.192, 95% confidence interval (CI)=1.07-1.328, P=0.001], living alone (OR=4.827, 95% CI=1.315-17.725, P=0.018), history of alcohol abuse (OR=3.875, 95% CI=1.168-12.857, P=0.026), longer duration of primary PCI (OR=1.152, 95% CI=1.077-1.232, P<0.001) and post-operative pain (current pain; OR=7.663, 95% CI=1.432-41.02, P=0.017). Compared to the patients without delirium, the participants who developed delirium had longer hospital stays and a higher rate of re-admission within 30 days after discharge. The mortality within one year after discharge (one-year mortality) was similar between patients with and without delirium. In conclusion, older patients (age, ≥65 years) with acute STEMI are at a relatively high risk of delirium following primary PCI. Higher age (≥65 years), living alone, history of alcohol dependence, longer length of primary PCI (>50 min) and post-operative pain (current pain) were determined to be risk factors for delirium after primary PCI in the present cohort.
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