Circulation reports · 2024
Impact of Cognitive Impairment on Long-Term Outcomes After Transcatheter Aortic Valve Implantation.
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Miyawaki Norihisa, Ishizu Kenichi, Shirai Shinichi, Miyahara Katsunori, Yamamoto Ko, Suenaga Tomohiro, Otani Akira, Nakano Kenji, Fukushima Tadatomo, Ko Euihong, Tsuru Yasuo, Nakamura Miho, Morofuji Toru, Morinaga Takashi, Hayashi Masaomi, Isotani Akihiro, Ohno Nobuhisa, Kakumoto Shinichi, Ando Kenji
Аннотация
BACKGROUND: Cognitive impairment assessed using the Mini-Mental Status Examination (MMSE) is associated with short-term mortality after transcatheter aortic valve implantation (TAVI). We assessed the long-term prognostic impact of cognitive impairment in patients with severe aortic stenosis post-TAVI.
METHODS AND RESULTS: We enrolled 1,057 consecutive patients who underwent TAVI at the Kokura Memorial Hospital and prospectively assessed them using the MMSE. Results showed that 319 (30%) patients had cognitive impairment. Compared with normal cognition, cognitive impairment was associated with an increased risk for 5-year all-cause mortality (55% vs. 39%; P<0.001), cardiovascular mortality (23% vs. 14%; P=0.007), and non-cardiovascular mortality (42% vs. 29%; P<0.001). Multivariable analysis showed that cognitive impairment was independently associated with all-cause mortality (adjusted hazard ratio [aHR] 1.37; 95% confidence interval [CI] 1.10-1.70; P=0.005), and this result was consistent regardless of stratification based on age, sex, body mass index, left ventricular ejection fraction and clinical frailty scale without significant interaction. Patients with MMSE scores <16 had a significantly higher mortality rate compared with patients with MMSE scores >25, 21-25, and 16-20, respectively.
CONCLUSIONS: Cognitive impairment assessed using MMSE scores is independently associated with an increased risk for 5-year all-cause mortality in patients undergoing TAVI.
METHODS AND RESULTS: We enrolled 1,057 consecutive patients who underwent TAVI at the Kokura Memorial Hospital and prospectively assessed them using the MMSE. Results showed that 319 (30%) patients had cognitive impairment. Compared with normal cognition, cognitive impairment was associated with an increased risk for 5-year all-cause mortality (55% vs. 39%; P<0.001), cardiovascular mortality (23% vs. 14%; P=0.007), and non-cardiovascular mortality (42% vs. 29%; P<0.001). Multivariable analysis showed that cognitive impairment was independently associated with all-cause mortality (adjusted hazard ratio [aHR] 1.37; 95% confidence interval [CI] 1.10-1.70; P=0.005), and this result was consistent regardless of stratification based on age, sex, body mass index, left ventricular ejection fraction and clinical frailty scale without significant interaction. Patients with MMSE scores <16 had a significantly higher mortality rate compared with patients with MMSE scores >25, 21-25, and 16-20, respectively.
CONCLUSIONS: Cognitive impairment assessed using MMSE scores is independently associated with an increased risk for 5-year all-cause mortality in patients undergoing TAVI.