Abstract P254: Dementia and Use of Cardiac Catheterization and Angioplasty in Elderly ST-Elevation Myocardial Infarction Patients

Abstract

Introduction_ Percutaneous coronary intervention (PCI) is the first line of treatment for ST-elevated myocardial infarction (STEMI). Few studies addressed dementia as a barrier to receiving PCI. We evaluated disparities in the use of cardiac catheterization and PCI in STEMI patients with dementia. Methods_ A retrospective analysis was performed of Florida's comprehensive inpatient surveillance system for the years 2006-2007 with admission diagnosis of STEMI (ICD-9-CM codes 410.0 - 410.6, 410.8). Data were limited to patients ≥65 years admitted to hospitals with a high annual volume of PCIs (≥400), and transfer patients were excluded. We used a broad definition of dementia (ICD-9-CM codes 294.0, 294.1, 294.8, 294.9, 331.0-331.2, 331.7, 331.81, 331.82, 331.89, 331.9, 780.93, 780.97, 797). Logistic regression analysis was used to identify disparities in the use of cardiac catheterization and PCI among all STEMI patients, and in the use of PCI only among STEMI patients who received cardiac catheterization. Results_ A total of 8,310 STEMI patients who met our inclusion criteria were identified. Of these, 77.2% were catheterized and 67.1% received PCI. The mean age of the cohort was 76.3 years (SD 7.8 yrs); with 43.3% female; 83.4% white, 4.6% black, and 12% Hispanic/other. A total of 605 (7.3%) were demented. After adjustment for age, gender, and race/ethnicity, patients with dementia were less likely to be catheterized (RR 0.4, 95% CI 0.3-0.5), and less likely to receive PCI (RR 0.4, 95% CI 0.4-0.5) than non-demented patients. However, among patients who were catheterized, there was no difference in the use of PCI for demented vs. non-demented patients (p=0.32).Women were less likely to be catheterized than males (RR 0.7, 95% CI 0.7-0.8), but if catheterized, were more likely to receive PCI then men (RR 1.3, 95% CI 1.1-1.6). After adjustment for age, gender, and dementia, blacks were less likely to be catheterized (RR 0.5, 95% CI 0.4-0.6) and less likely to receive PCI (RR 0.6, 95% CI 0.5-0.7) than whites. Conclusions_ STEMI patients with dementia were much less likely to receive cardiac catheterization and consequently PCI. Our study confirms that treatment disparities exist for elderly demented patients after controlling for age, gender and ethnicity.