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Dementia Is Associated With Higher One-Year Mortality and Worse Patient-Centered Outcomes in Patients Undergoing

Khanjan B Shah1, Lingwei Xiang2, Samir K Shah3

  • 1Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA.

Cardiology Research
|April 22, 2026
PubMed

Insights

Patients with Alzheimer's disease and related dementias (ADRD) undergoing percutaneous coronary intervention (PCI) with mechanical circulatory support (MCS) for myocardial infarction have similar inpatient survival but higher long-term mortality and need for higher care levels.

Area of Science:

  • Cardiology
  • Geriatrics
  • Neurology

Background:

  • Percutaneous coronary intervention (PCI) with mechanical circulatory support (MCS) improves outcomes for ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS).
  • Clinical outcomes for patients with Alzheimer's disease and related dementias (ADRD) in this setting are unknown due to trial exclusions.
  • Navigating time-sensitive decisions for ADRD patients with STEMI or CS presents challenges for clinicians and caregivers.

Purpose of the Study:

  • To assess the association of ADRD with outcomes following PCI with MCS for STEMI or CS.
  • To compare inpatient mortality, 1-year mortality, complications, and readmissions between patients with and without ADRD.

Main Methods:

  • Retrospective cohort study of Medicare fee-for-service beneficiaries aged 66+ from July 2017 to December 2019.
  • Comparison of patients with and without ADRD undergoing PCI with MCS for STEMI or CS.
  • Primary outcome: inpatient mortality; Secondary outcomes: 1-year mortality, complications, readmissions, time-at-home ratio, and discharge disposition.

Main Results:

  • Of 13,110 patients, 988 (7.5%) had ADRD and were older and more frail.
  • Inpatient mortality was similar (OR 1.05, 95% CI 0.92-1.21).
  • 1-year mortality was higher in the ADRD group (OR 1.41, 95% CI 1.21-1.64), with similar complications and readmissions. ADRD patients had higher discharge to higher care levels (OR 1.46, 95% CI 1.16-1.82).

Conclusions:

  • Patients with ADRD undergoing PCI with MCS for STEMI/CS show similar inpatient mortality and complication rates.
  • Higher 1-year mortality and increased likelihood of discharge to a higher level of care are observed in patients with ADRD.
  • These findings highlight the need for careful consideration of long-term outcomes and post-discharge care planning for ADRD patients receiving advanced cardiac interventions.
Abstract

Keywords:
Cardiogenic shockCoronary artery diseaseDementiaPCISTEMI

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