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Am Fam Physician. 2021;104(4):422

Clinical Question

Are older adults with coronary artery disease (CAD) at an increased risk of accelerated memory decline after coronary revascularization with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)?

Bottom Line

The study found no significant difference in the rate of memory decline among older adults with CAD who are undergoing coronary revascularization with CABG or PCI. (Level of Evidence = 2c)

Synopsis

It is uncertain if the rate of memory decline in older people with CAD is changed after CABG or PCI. The investigators analyzed data obtained from a large prospective longitudinal survey of community-dwelling participants beginning in 1992 in the United States. Study participants included adults 65 years or older who underwent CABG, on pump or off pump, and PCI. As part of the study, participants took regular cognitive tests to assess longitudinal memory change. Analyses were adjusted for multiple potential confounders including age, education, financial assets, body mass index, smoking status, presence of daily pain or difficulty with activities of daily living, depression, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, stroke, heart disease, and race and ethnicity. The mean rate of memory decline was not significantly different before and after CABG or PCI. There was a statistically significant increase in the rate of memory decline after off-pump CABG compared with PCI, but not after on-pump CABG compared with PCI. The authors note that off-pump CABG is increasingly viewed as a less durable method of revascularization.

Study design: Cohort (retrospective)

Funding source: Government

Setting: Population-based

Reference:WhitlockELDiaz-RamirezLGSmithAKet alAssociation of coronary artery bypass grafting vs percutaneous coronary intervention with memory decline in older adults undergoing coronary revascularization. JAMA2021;325(19):1955–1964.

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POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

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A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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