Coronary Revascularization and Postoperative Outcomes in People With and Without Alzheimer's Disease

Little is known on the incidence and postoperative outcomes of revascularizations according to electivity in persons with Alzheimer's disease (AD).

The Medication Use and Alzheimer's disease (MEDALZ) cohort includes 70 718 community dwellers diagnosed with incident AD during 2005-2011 in Finland. For each person with AD, 1-4 age-, sex-, and hospital district-matched comparison persons without AD were identified. Altogether 448 persons with AD and 5909 without AD underwent revascularization during the follow-up. The outcomes were 30-day and 90-day re-admission rate after discharge, and all-cause 1-year and 3-year mortality. Risk of outcomes in persons with AD were compared to those without AD using Cox proportional hazard models adjusted with age, sex, comorbidities, statin use, revascularization type, length of stay, and support at discharge.

People with AD had less revascularizations (adjusted hazard ratio 0.24, 95% confidence interval 0.22-0.27). Emergency procedures were more common (42.6% vs 33.1%) than elective procedures (34.2% vs 48.6%) among people with AD. There was no difference in 30-day readmissions (0.97, 0.80-1.17) or 1-year mortality (1.04, 0.75-1.42) and 90 days readmission risk was lower in persons with AD (0.85, 0.74-0.98). People with AD had higher 3-year mortality (1.42, 1.15-1.74), but the risk increase was observed only for emergency (1.71, 1.27-2.31), not for elective procedures (0.96, 0.63-1.46).

People with AD did not have worse readmission and mortality outcomes following elective revascularization. These findings in conjunction with lower revascularization rate especially for elective procedures raise questions on the threshold for elective procedures in people with AD.