Cognitive Decline in Older Patients With Non‐ST Elevation Acute Coronary Syndrome

Gu, Sophie Zhaotao; Beska, Benjamin; Chan, Danny; Neely, Dermot; Batty, Jonathan A.; Adams‐Hall, Jennifer; Mossop, Helen; Qiu, Weiliang; Kunadian, Vijay

doi:10.1161/jaha.118.011218

Cited by 42 publications

(28 citation statements)

References 26 publications

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“…In one study of older patients undergoing invasive management of non-ST segment ACS (mean age 80.5 AE 4.8 years), undiagnosed cognitive impairment was identified as being highly prevalent. 7 The authors of this study also found that recurrent myocardial infarction was independently associated with cognitive decline at one year. In another study, frailty was found to be associated with an increased risk of major events and hospital readmissions in elderly ACS patients.…”

Section: Prevalence and Patterns Of Cognitive Impairment In Acute Corsupporting

confidence: 53%

Prevalence and patterns of cognitive impairment in acute coronary syndrome patients: A systematic review

Pottle

2019

Eur J Prev Cardiolog

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Section: Prevalence and Patterns Of Cognitive Impairment In Acute Corsupporting

confidence: 53%

Prevalence and patterns of cognitive impairment in acute coronary syndrome patients: A systematic review

Pottle

2019

Eur J Prev Cardiolog

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“…The Improve Cardiovascular Outcomes in high-risk older patients with acute coronary syndrome (ICON1) study is a multicentre prospective cohort study which aimed to develop a risk score for high-risk older adults, the FRAIL-HEART score. [7][8][9] The study protocol has been published previously [10]. The current study is a planned study as outlined in the the ICON1 study protocol [10].…”

Section: Methodsmentioning

confidence: 99%

The association of telomere length and telomerase activity with adverse outcomes in older patients with non-ST-elevation acute coronary syndrome

et al. 2020

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Background Non-ST elevation acute coronary syndrome (NSTEACS) occurs more frequently in older patients with an increased occurrence of recurrent cardiac events following the index presentation. Telomeres are structures consisting of repeated DNA sequences as associated shelterin proteins at the ends of chromosomes. We aim to determine whether telomere length (TL) and telomerase activity (TA) predicted poor outcomes in older patients presenting with NSTEACS undergoing invasive care. Method Older patients undergoing invasive management for NSTEACS were recruited to the ICON-1 biomarker study (NCT01933581). Peripheral blood mononuclear cells (PBMC) were recovered on 153 patients. DNA was isolated and mean TL was measured by quantitative PCR expressed as relative T (telomere repeat copy number) to S (single copy gene number) ratio (T/S ratio), and a telomere repeat amplification assay was used to assess TA during index presentation with NSTEACS. Primary clinical outcomes consisted of death, myocardial infarction (MI), unplanned revascularisation, stroke and significant bleeding recorded at 1 year. TL and TA were divided into tertile groups for analysis. Cox proportional hazards regression was performed. Ordinal regression was performed to evaluate the relationship between TL and TA and traditional cardiovascular risk factors at baseline. Results 298 patients were recruited in the ICON-1 study of which 153 had PBMC recovered. The mean age was 81.0 ± 4.0 years (64% male). Mean telomere length T/S ratio was 0.47 ±

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“…The ICON1 study is a multi-centre prospective cohort study that aims to determine the predictors of adverse outcomes following interventional management of NSTEACS in older patients, with an overall aim of producing a quantitative risk score for this population, the FRAIL-HEART score. [15] [16, 17]…”

Section: Methodsmentioning

confidence: 99%

The association between vitamin D status and clinical events in high-risk older patients with non-ST elevation acute coronary syndrome undergoing invasive management

Beska

Chan

et al. 2019

PLoS ONE

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There is a higher incidence of vitamin D deficiency in older adults. This may play a plausible mechanistic role in the occurrence of increased adverse events after non-ST elevation acute coronary syndrome (NSTEACS). This study investigated whether total vitamin D levels at the time of presentation predicted adverse outcomes in older adults undergoing invasive management of NSTEACS. Of the 629 patients screened, 300 high-risk older adults with NSTEACS managed by an invasive strategy were recruited. Serum total 25-hydroxyvitamin D was measured at index presentation. The primary outcome was defined as 1-year composite of all-cause mortality, acute coronary syndrome (ACS), unplanned repeat revascularisation, significant bleeding or stroke. Mean age was 80.5±4.8 years (61.9% male). Median vitamin D level was 29.5nmol/L [interquartile range IQR 16.0–53.0 nmol/L] and was split equally by the median for analysis forming two groups: high (median vitamin D 53.0 nmol/L [IQR 40.0–75.0]) and low (16.0 nmol/L [11.0–23.0]). The primary outcome occurred in 76 patients (25.9%); 32 (21.9%) in the low group and 44 (29.9%) in the high group, p = 0.12. Multivariable analyses showed no significant difference in the primary composite outcome at 1 year between the low and high group of baseline serum vitamin D (Hazard Ratio 1.20 [95% Confidence Interval 0.72–2.0], p = 0.48). Serum total vitamin D, measured at the time of angiography, was not associated with adverse outcomes at one year in this high-risk older cohort of patients with NSTEACS undergoing invasive management.

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Cognitive Decline in Older Patients With Non‐ST Elevation Acute Coronary Syndrome

Abstract: See Editorial by Lowenstern and Wang

Cited by 42 publications

References 26 publications

Prevalence and patterns of cognitive impairment in acute coronary syndrome patients: A systematic review

Prevalence and patterns of cognitive impairment in acute coronary syndrome patients: A systematic review

The association of telomere length and telomerase activity with adverse outcomes in older patients with non-ST-elevation acute coronary syndrome

The association between vitamin D status and clinical events in high-risk older patients with non-ST elevation acute coronary syndrome undergoing invasive management

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