Frequency and Consequences of Cognitive Impairment in Patients Underwent Transcatheter Aortic Valve Implantation

Ryo Yanagisawa, Makoto Tanaka, Fumiaki Yashima, Takahide Arai, Takashi Kono, Hideyuki Shimizu, Keiichi Fukuda, Toru Naganuma, Kazuki Mizutani, Motoharu Araki, Norio Tada, Futoshi Yamanaka, Shinichi Shirai, Minoru Tabata, Hiroshi Ueno, Kensuke Takagi, Akihiro Higashimori, Yusuke Watanabe, Masanori Yamamoto, Kentaro Hayashida

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5 Citations (Scopus)

Abstract

Cognitive impairment is common in patients underwent transcatheter aortic valve implantation (TAVI) and might affect procedure outcomes. This study evaluated the incidence of preprocedural cognitive impairment and its impact on clinical outcomes after TAVI. We analyzed the data of 1,111 patients (age ≥70 years) obtained from the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry. The cognitive performance of all patients was assessed using the Mini-Mental State Examination (MMSE) at baseline. We evaluated the 1-year cumulative mortality after TAVI according to the MMSE performance. Cognitive impairment was present in 420 (38%) of 1,111 patients. Compared with patients with normal cognition, those with cognitive impairment showed higher cumulative all-cause and noncardiovascular mortality rates at 1 year (14% vs. 8%, p = 0.001; 11% vs. 5%, p <0.001, respectively). Moreover, cognitive impairment increased the risk of mortality from sepsis (2% vs. 0.4%; hazard ratio, 4.2; 95% confidence interval, 1.3 to 13.5; p = 0.02). In adjusted models, cognitive impairment was an independent risk factor for 1-year all-cause mortality (adjusted hazard ratio, 2.1; 95% confidence interval, 1.1 to 4.0; p = 0.02). Although patients with cognitive impairment had more in-hospital adverse outcomes, including prolonged hospital stays, major bleeding and vascular complications, and acute kidney injury, than did those with normal cognition, the 30-day mortality was similar between the groups (1% in the two groups; p >0.99). In conclusion, cognitive impairment based on the MMSE score was an independent predictor of mortality at 1 year after TAVI.

Original languageEnglish
JournalAmerican Journal of Cardiology
DOIs
Publication statusAccepted/In press - 2018 Jan 1

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Yanagisawa, R., Tanaka, M., Yashima, F., Arai, T., Kono, T., Shimizu, H., Fukuda, K., Naganuma, T., Mizutani, K., Araki, M., Tada, N., Yamanaka, F., Shirai, S., Tabata, M., Ueno, H., Takagi, K., Higashimori, A., Watanabe, Y., Yamamoto, M., & Hayashida, K. (Accepted/In press). Frequency and Consequences of Cognitive Impairment in Patients Underwent Transcatheter Aortic Valve Implantation. American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2018.05.026