Incidence of Dementia in Older Adults Hospitalized With Acute Coronary Syndrome

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Coronary Syndrome (n=25176). Intervention: Coronary revascularization (PCI or CABG) vs. No revascularization (medical management). Primary outcome: Incident dementia after a 1-year washout (sub-HR 1.05, 95% CI 0.95-1.17, p=0.36).

Q: What does this research mean for the field?

Coronary revascularization in older adults with acute coronary syndrome is not associated with an increased risk of incident dementia compared with no revascularization or stable coronary artery disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ashok Krishnaswami; Amanda Jain; Paola Gilsanz; Wynnelena Canio; Richard Ha; Deepak L. Bhatt; Mathew S. Maurer; Michael G. Nanna; Neelum T. Aggarwal; Michelle M. Mielke; Annabelle Santos Volgman; Howard Dinh; Janine Y. Yang; Edward D. Shin; Abdulla A. Damluji; Ahmed Shah

doi:10.1016/j.jacadv.2026.103192

August 28, 2026JACC AdvancesOpen Access

Incidence of Dementia in Older Adults Hospitalized With Acute Coronary Syndrome

View Full Paper

Ask AI

Bookmark

Share

Key result

Coronary revascularization was not significantly associated with an increased risk of incident dementia compared with no revascularization among older adults with acute coronary syndrome (sub-HR 1.05, 95% CI 0.95-1.17, p=0.36).

Figures

Graphical abstract published by JACC Advances — Graphical abstract · Published by JACC Advances · CC BY

Why the study?

Cognitive decline has been reported after coronary revascularization, but whether it reflects procedure-specific effects or underlying vascular disease burden remains uncertain.

Does coronary revascularization increase the risk of incident dementia compared to medical management in older adults hospitalized with acute coronary syndrome?

Key Points

To determine whether incident dementia risk differs according to coronary revascularization strategy among older adults hospitalized with acute coronary syndrome (ACS).
Longitudinal cohort study of adults aged ≥65 years hospitalized for ACS between 2010 and 2020 (n = 25,176) receiving PCI (n = 8,043), CABG (n = 797), or no revascularization (n = 16,336), with a comparator cohort of stable CAD without revascularization (n = 154,299).
Primary outcome was incident dementia identified using validated ICD codes after a 1-year washout period over a median 4.8 years of follow-up, analyzed with propensity score-matched Cox models accounting for competing risk of death.
Over follow-up, 9.0% of ACS patients developed dementia (9.3% for total revascularization [9.4% PCI, 8.7% CABG] vs 8.9% without revascularization), compared with 10.9% in the stable CAD cohort.
Dementia risk did not differ significantly between revascularization modalities, with a sub-hazard ratio of 0.98 (95% CI: 0.75-1.28; P = 0.88) for CABG versus PCI in propensity-matched analyses.

Study Design

Type

Cohort (n=25,176)

Multicenter

Yes

Structured PICO

Does coronary revascularization increase the risk of incident dementia compared to medical management in older adults hospitalized with acute coronary syndrome?

P

Population

25,176 adults aged ≥65 years hospitalized for acute coronary syndrome, followed for a median of 4.8 years to assess incident dementia.

E

Exposure

Coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting)

C

Comparator

No revascularization (medically managed ACS) and a second comparator of stable coronary artery disease without revascularization

O

Outcome

Incident all-cause dementia identified using validated ICD codes after a 1-year washouthard clinical

Main Result

Hazard Ratio: 1.05 (95% CI 0.95–1.17)

Absolute Event Rate: 9.3% vs 8.9%

p-value: p=0.36

Coronary revascularization in older adults with ACS does not increase the long-term risk of dementia compared to medical management, suggesting cognitive decline is driven by underlying vascular disease rather than procedure-specific neurotoxicity.

Limitations

Dementia diagnoses were based on ICD codes rather than standardized neuropsychological testing
Residual confounding from unmeasured factors such as baseline cognitive reserve, frailty, or social determinants of health cannot be excluded
Lack of direct measures of procedural characteristics, such as pump time
Some medically managed patients diagnosed with ACS may have had other diagnoses such as pericarditis and myocarditis
Results reflect practice patterns within an integrated healthcare delivery system and may not generalize to other populations
Observational nature of the study
Dementia diagnoses based on ICD codes rather than standardized neuropsychological testing
Residual confounding from unmeasured factors
Lack of direct measures of procedural characteristics
Potential misclassification of ACS in medically managed group
Single integrated healthcare delivery system may limit generalizability
Observational design

Implication

May reassure on dementia risk with revascularization in older ACS patients; challenges prior reports of post-procedure harm and leaves open vascular disease mechanisms.

Abstract

BACKGROUND: Cognitive decline has been reported after coronary artery revascularization, but whether it reflects procedure-specific effects or the burden of underlying vascular disease remains uncertain. OBJECTIVES: To determine whether incident dementia risk differs according to coronary revascularization strategy among older adults with acute coronary syndrome (ACS). METHODS: We conducted a longitudinal cohort study among adults aged ≥65 years hospitalized for ACS between 2010 and 2020 (n = 25,176). Patients underwent percutaneous coronary intervention (n = 8,043), coronary artery bypass grafting (n = 797), or received no revascularization (n = 16,336). A second comparator cohort included patients with stable coronary artery disease (CAD) without revascularization (n = 154,299). The primary outcome was incident dementia identified using validated International Classification of Diseases codes after a 1-year washout. Propensity-matched analyses used Cox models accounting for the competing risk of death. RESULTS: Revascularized patients were younger (74.8 ± 6.9 vs 77.1 ± 8.2 years), more often male (66.2% vs 54.0%), and had lower Elixhauser multimorbidity scores (4.6 ± 2.8 vs 5.4 ± 3.0, all P < 0.001). Over a median 4.8 years of follow-up, 9.0% of ACS patients developed dementia. Revascularization was not associated with increased dementia risk compared with ACS without revascularization (sub-hazard ratio: 1.05; 95% CI: 0.95-1.17) or stable CAD. Dementia risk was also similar between percutaneous coronary intervention and coronary artery bypass grafting. CONCLUSIONS: We found that among older adults with ACS, coronary revascularization was not statistically significantly associated with increased dementia risk compared with no revascularization or stable CAD. These findings reflect the hypothesis that the majority of dementia risk is potentially driven more by cumulative vascular and systemic factors than by procedure-specific neurotoxicity.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Krishnaswami et al. (2026) conducted a cohort in Acute Coronary Syndrome (n=25,176). Coronary revascularization (PCI or CABG) vs. No revascularization (medical management) was evaluated on Incident dementia after a 1-year washout (sub-HR 1.05, 95% CI 0.95-1.17, p=0.36). Coronary revascularization was not significantly associated with an increased risk of incident dementia compared with no revascularization among older adults with acute coronary syndrome (sub-HR 1.05, 95% CI 0.95-1.17, p=0.36).

synapsesocial.com/papers/6a93f08e6c1a8fb52e79cc2f https://doi.org/10.1016/j.jacadv.2026.103192

View Full Paper

Ask AI

Bookmark

Share

Incidence of Dementia in Older Adults Hospitalized With Acute Coronary Syndrome

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Incidence of Dementia in Older Adults Hospitalized With Acute Coronary Syndrome

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading