Complex or multivessel PCI is associated with higher 1-year mortality but better patient-centered outcomes when compared to CABG in patients with dementia.

Abstract

Objectives: To compare outcomes of coronary revascularization with coronary artery bypass grafting (CABG) or complex or multivessel percutaneous coronary intervention (MV PCI) in patients with dementia.

Methods: We compared outcomes of Medicare fee-for-service (FFS) beneficiaries 66 years or older with Alzheimer's disease and related dementias (ADRD) who underwent coronary artery bypass grafting (CABG) or MV PCI from January 1, 2017 to December 31, 2019. The primary clinical outcome was 1-year mortality, and secondary clinical outcomes were inpatient and 90-day complications and 90-day readmissions. Patient-centered outcomes were time-at-home ratio and discharge to higher level of care.

Results: 8,939 patients with ADRD undergoing revascularization with CABG MV PCI met study criteria. Of these, 3,510 (39.3%) underwent CABG and 5,429 (60.7%) underwent MV PCI. Patients with ADRD who underwent MV PCI were more likely to be older (81.0 vs. 76.7, P < 0.001), women (44.1% vs. 29.4%, P < 0.001), frail (82.4% vs. 75.0%, P < 0.001), and have moderate to severe dementia (64.4% vs. 54.6%, P < 0.001). One-year mortality was higher among patients undergoing MV PCI (OR = 2.0, 95% CI: 1.8-2.3) but inpatient and 90-day major complications were lower (OR = 0.3, 95% CI: 0.3-0.3 and OR = 0.5, 95% CI: 0.4-0.5, respectively). Patients with ADRD undergoing MV PCI were less likely to be discharged to a higher level of care (OR = 0.2, 95% CI: 0.2-0.2) and had higher time-at-home ratios (Mean Difference 4.2, 95% CI: 2.4-6.0).

Conclusions: Patients with ADRD undergoing MV PCI demonstrate higher 1-year mortality but lower short-term complications. Patient-centered outcomes of time-at-home ratio and risk for discharge to a higher level of care were more favorable with MV PCI compared to CABG. These data should be used by patients, their families, and physicians to facilitate goal-concordant care especially when optimization of patient-centered outcomes is desired.