Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 2, April 2026, pages 128-135

Dementia Is Associated With Higher One-Year Mortality and Worse Patient-Centered Outcomes in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction and Cardiogenic Shock

↓ Figure 1. Study enrollment flowchart. This flowchart demonstrates the number of patients who were eligible for the study and how that number changed after utilizing inclusion and exclusion criteria. STEMI: ST-segment elevation myocardial infarction; CS: cardiogenic shock; PCI: percutaneous coronary intervention; MCS: mechanical circulatory support; ADRD: Alzheimer’s disease and related dementias; CAHs: critical access hospitals; FFS: fee-for-service.

↓ Figure 2. Kaplan–Meier estimate. The Kaplan–Meier curves demonstrate survival curves in patients with ADRD (red) compared to those without ADRD (blue). Patients with ADRD are more likely to die following PCI with MCS for STEMI or CS over 1 year. STEMI: ST-segment elevation myocardial infarction; CS: cardiogenic shock; PCI: percutaneous coronary intervention; MCS: mechanical circulatory support; ADRD: Alzheimer’s disease and related dementias.

↓ **Table 1.** Baseline Characteristics by ADRD Status
	All, n (%)	ADRD	P value
^aRemoved dementia coefficients from frailty calculation to avoid double counting dementia. ^bAnalysis restricted to patients underwent HRPCI before January 1, 2019. ^cMedian (IQR). HRPCI: high-risk percutaneous coronary intervention; ADRD: Alzheimer’s disease and related dementias; IQR: interquartile range.
Dual eligibility, yes, n (%)	2,126 (16.2)	1,853 (15.3)	273 (27.6)	< 0.001
Frail^a, yes, n (%)	3,131 (23.9)	2,667 (22.0)	464 (47.0)	< 0.001
Community dwelling^b, n (%)
Community dwelling	9,554 (94.7)	8,947 (96.0)	607 (79.2)	< 0.001
Non-community dwelling	536 (5.3)	377 (4.0)	159 (20.8)
Race, n (%)
Unknown	155 (1.2)			< 0.001
Non-Hispanic White	10,863 (82.9)	10,087 (83.2)	776 (78.5)
Black or African-American	762 (5.8)	666 (5.5)	96 (9.7)
Other	124 (0.9)
Asian/Native American	484 (3.7)	455 (3.8)	29 (2.9)
Hispanic	722 (5.5)	651 (5.4)	71 (7.2)
Sex, n (%)
Male	8,240 (62.9)	7,701 (63.5)	539 (54.6)	< 0.001
Female	4,870 (37.1)	4,421 (36.5)	449 (45.4)
Admission urgency, n (%)
Other	3,767 (28.7)	3,517 (29.0)	250 (25.3)	0.01
Urgent/emergent	9,343 (71.3)	8,605 (71.0)	738 (74.7)
Patient geography, n (%)
Metropolitan	9,889 (75.4)	9,147 (75.5)	742 (75.1)	0.80
Non-metropolitan	3,221 (24.6)	2,975 (24.5)	246 (24.9)
Age^c	75.8 (70.8, 81.8)	75.5 (70.5, 81.3)	81.1 (75.3, 86.1)	< 0.001
Elixhauser in-hospital mortality index^c	16 (8, 24)	16 (8, 24)	18 (8, 31)	< 0.001
Cerebrovascular disease, n (%)	1,073 (8.2)	941 (7.8)	132 (13.4)	< 0.001
Coagulopathy, n (%)	1,542 (11.8)	1,412 (11.6)	130 (13.2)	0.16
Depression, n (%)	1,862 (14.2)	1,532 (12.6)	330 (33.4)	< 0.001
Diabetes with chronic complications, n (%)	4,967 (37.9)	4,528 (37.4)	439 (44.4)	< 0.001
Diabetes without chronic complications, n (%)	4,590 (35.0)	4,139 (34.1)	451 (45.6)	< 0.001
Heart failure, n (%)	10,404 (79.4)	9,583 (79.1)	821 (83.1)	0.003
Hypertension, complicated, n (%)	8,307 (63.4)	7,595 (62.7)	712 (72.1)	< 0.001
Hypertension, uncomplicated, n (%)	8,923 (68.1)	8,167 (67.4)	756 76.5)	< 0.001
Chronic pulmonary disease, n (%)	3,691 (28.2)	3,359 (27.7)	332 (33.6)	< 0.001
Neurological disorders affecting movement, n (%)	358 (2.7)	287 (2.4)	71 (7.2)	< 0.001
Other neurological disorders, n (%)	1,022 (7.8)	823 (6.8)	199 (20.1)	< 0.001
Seizures and epilepsy, n (%)	298 (2.3)	243 (2.0)	55 (5.6)	< 0.001
Obesity, n (%)	3,061 (23.3)	2,855 (23.6)	206 (20.9)	0.05
Peripheral vascular disease, n (%)	3,933 (30.0)	3,570 (29.5)	363 (36.7)	< 0.001
Psychoses, n (%)	193 (1.5)	136 (1.1)	57 (5.8)	< 0.001
Renal failure, moderate, n (%)	3,300 (25.2)	2,984 (24.6)	316 (32.0)	< 0.001
Renal failure, severe, n (%)	1,454 (11.1)	1,314 (10.8)	140 (14.2)	0.001
Weight loss, n (%)	1,025 (7.8)	903 (7.4)	122 (12.3)	< 0.001

↓ Table 1. Baseline Characteristics by ADRD Status

All, n (%)

ADRD

P value

No (n = 12,122)

Yes (n = 988)

^aRemoved dementia coefficients from frailty calculation to avoid double counting dementia. ^bAnalysis restricted to patients underwent HRPCI before January 1, 2019. ^cMedian (IQR). HRPCI: high-risk percutaneous coronary intervention; ADRD: Alzheimer’s disease and related dementias; IQR: interquartile range.

Dual eligibility, yes, n (%)

2,126 (16.2)

1,853 (15.3)

273 (27.6)

< 0.001

Frail^a, yes, n (%)

3,131 (23.9)

2,667 (22.0)

464 (47.0)

< 0.001

Community dwelling^b, n (%)

Community dwelling

9,554 (94.7)

8,947 (96.0)

607 (79.2)

< 0.001

Non-community dwelling

536 (5.3)

377 (4.0)

159 (20.8)

Race, n (%)

Unknown

155 (1.2)

< 0.001

Non-Hispanic White

10,863 (82.9)

10,087 (83.2)

776 (78.5)

Black or African-American

762 (5.8)

666 (5.5)

96 (9.7)

Other

124 (0.9)

Asian/Native American

484 (3.7)

455 (3.8)

29 (2.9)

Hispanic

722 (5.5)

651 (5.4)

71 (7.2)

Sex, n (%)

Male

8,240 (62.9)

7,701 (63.5)

539 (54.6)

< 0.001

Female

4,870 (37.1)

4,421 (36.5)

449 (45.4)

Admission urgency, n (%)

Other

3,767 (28.7)

3,517 (29.0)

250 (25.3)

0.01

Urgent/emergent

9,343 (71.3)

8,605 (71.0)

738 (74.7)

Patient geography, n (%)

Metropolitan

9,889 (75.4)

9,147 (75.5)

742 (75.1)

0.80

Non-metropolitan

3,221 (24.6)

2,975 (24.5)

246 (24.9)

Age^c

75.8 (70.8, 81.8)

75.5 (70.5, 81.3)

81.1 (75.3, 86.1)

< 0.001

Elixhauser in-hospital mortality index^c

16 (8, 24)

18 (8, 31)

< 0.001

Cerebrovascular disease, n (%)

1,073 (8.2)

941 (7.8)

132 (13.4)

< 0.001

Coagulopathy, n (%)

1,542 (11.8)

1,412 (11.6)

130 (13.2)

0.16

Depression, n (%)

1,862 (14.2)

1,532 (12.6)

330 (33.4)

< 0.001

Diabetes with chronic complications, n (%)

4,967 (37.9)

4,528 (37.4)

439 (44.4)

< 0.001

Diabetes without chronic complications, n (%)

4,590 (35.0)

4,139 (34.1)

451 (45.6)

< 0.001

Heart failure, n (%)

10,404 (79.4)

9,583 (79.1)

821 (83.1)

0.003

Hypertension, complicated, n (%)

8,307 (63.4)

7,595 (62.7)

712 (72.1)

< 0.001

Hypertension, uncomplicated, n (%)

8,923 (68.1)

8,167 (67.4)

756 76.5)

< 0.001

Chronic pulmonary disease, n (%)

3,691 (28.2)

3,359 (27.7)

332 (33.6)

< 0.001

Neurological disorders affecting movement, n (%)

358 (2.7)

287 (2.4)

71 (7.2)

< 0.001

Other neurological disorders, n (%)

1,022 (7.8)

823 (6.8)

199 (20.1)

< 0.001

Seizures and epilepsy, n (%)

298 (2.3)

243 (2.0)

55 (5.6)

< 0.001

Obesity, n (%)

3,061 (23.3)

2,855 (23.6)

206 (20.9)

0.05

Peripheral vascular disease, n (%)

3,933 (30.0)

3,570 (29.5)

363 (36.7)

< 0.001

Psychoses, n (%)

193 (1.5)

136 (1.1)

57 (5.8)

< 0.001

Renal failure, moderate, n (%)

3,300 (25.2)

2,984 (24.6)

316 (32.0)

< 0.001

Renal failure, severe, n (%)

1,454 (11.1)

1,314 (10.8)

140 (14.2)

0.001

Weight loss, n (%)

1,025 (7.8)

903 (7.4)

122 (12.3)

< 0.001

↓ **Table 2.** Unadjusted Outcomes as Stratified by ADRD Status
	All	ADRD	P value
^aPatients who died within the follow-up time frame and without event of interest were removed from analysis. ^bPatients who were admitted from the highest level of care (hospital) were removed from the analysis. ^cAnalysis restricted to community dwelling patients underwent high-risk PCI before January 1, 2019. ^dAnalysis restricted to community dwelling patients who had high-risk PCI from January 1, 2017 to December 31, 2018. ^eMean ± standard error (SE).
Inpatient death, n (%)	4,845 (37.0)	4,431 (36.6)	414 (41.9)	< 0.001
90-day death, n (%)	6,620 (50.5)	6,017 (49.6)	603 (61.0)	< 0.001
1-year death, n (%)	7,448 (56.8)	6,745 (55.6)	703 (71.2)	< 0.001
Inpatient complication, n (%)	7,148 (54.5)	6,592 (54.4)	556 (56.3)	0.25
Respiratory, n (%)	4,244 (32.4)	3,918 (32.3)	326 (33.0)	0.66
Cardiac, n (%)	1,899 (14.5)	1,761 (14.5)	138 (14.0)	0.63
Infectious, n (%)	1,575 (12.0)	1,446 (11.9)	129 (13.1)	0.29
Surgical site, n (%)	25 (0.2)	25 (0.2)		0.15
Bleeding/embolism/thrombosis, n (%)	1,065 (8.1)	993 (8.2)	72 (7.3)	0.32
Renal, n (%)	2,899 (22.1)	2,703 (22.3)	196 (19.8)	0.07
90-day complication^a, n (%)	8,658 (79.2)	7,988 (78.7)	670 (85.6)	< 0.001
90-day respiratory^a, n (%)	5,272 (55.4)	4,881 (55.0)	391 (60.9)	0.004
90-day cardiac^a, n (%)	4,308 (51.1)	4,006 (50.7)	302 (55.9)	0.02
90-day infectious^a, n (%)	2,509 (32.6)	2,297 (31.9)	212 (42.1)	< 0.001
90-day surgical site^a, n (%)	85 (1.3)			1.00
90-day bleeding/embolism/thrombosis^a, n (%)	1,338 (19.1)	1,253 (19.0)	85 (20.0)	0.59
90-day renal^a, n (%)	4,149 (47.7)	3,859 (47.3)	290 (52.8)	0.01
Discharge to a higher level of care^b, n (%)	3,452 (52.8)	3,142 (51.6)	310 (70.0)	< 0.001
Disharge to home^c, n (%)	2,940 (30.8)	2,829 (31.6)	111 (18.3)	< 0.001
30-day readmission^a, n (%)	1,823 (25.5)	1,683 (25.2)	140 (30.4)	0.01
90-day readmission^a, n (%)	2,770 (39.5)	2,552 (38.8)	218 (49.5)	< 0.001
Hospital length of stay^e	7.3 ± 0.1	7.4 ± 0.1	7.0 ± 0.2	0.21
Home-time ratio^{d, e}	45.5 ± 0.5	46.1 ± 0.5	36.2 ± 1.7	< 0.001

↓ Table 2. Unadjusted Outcomes as Stratified by ADRD Status

All

ADRD

P value

Yes

^aPatients who died within the follow-up time frame and without event of interest were removed from analysis. ^bPatients who were admitted from the highest level of care (hospital) were removed from the analysis. ^cAnalysis restricted to community dwelling patients underwent high-risk PCI before January 1, 2019. ^dAnalysis restricted to community dwelling patients who had high-risk PCI from January 1, 2017 to December 31, 2018. ^eMean ± standard error (SE).

Inpatient death, n (%)

4,845 (37.0)

4,431 (36.6)

414 (41.9)

< 0.001

90-day death, n (%)

6,620 (50.5)

6,017 (49.6)

603 (61.0)

< 0.001

1-year death, n (%)

7,448 (56.8)

6,745 (55.6)

703 (71.2)

< 0.001

Inpatient complication, n (%)

7,148 (54.5)

6,592 (54.4)

556 (56.3)

0.25

Respiratory, n (%)

4,244 (32.4)

3,918 (32.3)

326 (33.0)

0.66

Cardiac, n (%)

1,899 (14.5)

1,761 (14.5)

138 (14.0)

0.63

Infectious, n (%)

1,575 (12.0)

1,446 (11.9)

129 (13.1)

0.29

Surgical site, n (%)

25 (0.2)

0.15

Bleeding/embolism/thrombosis, n (%)

1,065 (8.1)

993 (8.2)

72 (7.3)

0.32

Renal, n (%)

2,899 (22.1)

2,703 (22.3)

196 (19.8)

0.07

90-day complication^a, n (%)

8,658 (79.2)

7,988 (78.7)

670 (85.6)

< 0.001

90-day respiratory^a, n (%)

5,272 (55.4)

4,881 (55.0)

391 (60.9)

0.004

90-day cardiac^a, n (%)

4,308 (51.1)

4,006 (50.7)

302 (55.9)

0.02

90-day infectious^a, n (%)

2,509 (32.6)

2,297 (31.9)

212 (42.1)

< 0.001

90-day surgical site^a, n (%)

85 (1.3)

1.00

90-day bleeding/embolism/thrombosis^a, n (%)

1,338 (19.1)

1,253 (19.0)

85 (20.0)

0.59

90-day renal^a, n (%)

4,149 (47.7)

3,859 (47.3)

290 (52.8)

0.01

Discharge to a higher level of care^b, n (%)

3,452 (52.8)

3,142 (51.6)

310 (70.0)

< 0.001

Disharge to home^c, n (%)

2,940 (30.8)

2,829 (31.6)

111 (18.3)

< 0.001

30-day readmission^a, n (%)

1,823 (25.5)

1,683 (25.2)

140 (30.4)

0.01

90-day readmission^a, n (%)

2,770 (39.5)

2,552 (38.8)

218 (49.5)

< 0.001

Hospital length of stay^e

7.3 ± 0.1

7.4 ± 0.1

7.0 ± 0.2

0.21

Home-time ratio^{d, e}

45.5 ± 0.5

46.1 ± 0.5

36.2 ± 1.7

< 0.001

↓ **Table 3.** Adjusted Outcomes as Stratified by ADRD Status
Outcome	Estimated effect (β)	95% CI lower	95% CI upper	P value
^aPatients who died within the follow-up time frame and without event of interest were removed from analysis. ^bPatients who were admitted from the highest level of care (hospital) were removed from the analysis. ^cAnalysis restricted to community dwelling patients underwent high-risk PCI before January 1, 2019. ^dAnalysis restricted to community dwelling patients who had high-risk PCI from January 1, 2017 to December 31, 2018. ^eAll values in this row are mean differences (MD) with their 95% CIs. ^fAll values in this row are hazard ratios (HR) with their 95% CIs. ^gP values were calculated using the Chi-square test. CI: confidence interval.
Inpatient death	1.05	0.92	1.21	0.44^g
90-day death	1.22	1.06	1.41	0.005^g
1-year death	1.41	1.21	1.64	< 0.001^g
Inpatient complication	0.91	0.79	1.04	0.18^g
Respiratory	0.94	0.82	1.09	0.43^g
Cardiac	0.98	0.81	1.18	0.82^g
Infectious	0.88	0.72	1.07	0.19^g
Bleeding/embolism/thrombosis	0.84	0.65	1.08	0.16^g
Renal	0.76	0.64	0.90	0.001^g
90-day complication^a	1.10	0.88	1.37	0.41^g
90-day respiratory^a	1.01	0.85	1.20	0.94^g
90-day cardiac^a	1.01	0.83	1.21	0.94^g
90-day infectious^a	1.05	0.85	1.28	0.67^g
90-day bleeding/embolism/thrombosis^a	0.87	0.68	1.13	0.30^g
90-day renal^a	0.92	0.77	1.11	0.38^g
Discharge to higher level of care^b	1.46	1.16	1.82	0.001^g
Discharge to home^c	0.71	0.56	0.88	0.002^g
30-day readmission^a	1.00	0.81	1.24	1.00^g
90-day readmission^a	1.08	0.88	1.32	0.48^g
Hospital length of stay^e	–0.61	–1.11	–0.10	0.02
Home-time ratio^{d, e}	–3.16	–6.76	0.45	0.09
1-year mortality^f	1.12	1.04	1.22	0.003

↓ Table 3. Adjusted Outcomes as Stratified by ADRD Status

Outcome

Estimated effect (β)

95% CI lower

95% CI upper

P value

Inpatient death

1.05

0.92

1.21

0.44^g

90-day death

1.22

1.06

1.41

0.005^g

1-year death

1.41

1.21

1.64

< 0.001^g

Inpatient complication

0.91

0.79

1.04

0.18^g

Respiratory

0.94

0.82

1.09

0.43^g

Cardiac

0.98

0.81

1.18

0.82^g

Infectious

0.88

0.72

1.07

0.19^g

Bleeding/embolism/thrombosis

0.84

0.65

1.08

0.16^g

Renal

0.76

0.64

0.90

0.001^g

90-day complication^a

1.10

0.88

1.37

0.41^g

90-day respiratory^a

1.01

0.85

1.20

0.94^g

90-day cardiac^a

1.01

0.83

1.21

0.94^g

90-day infectious^a

1.05

0.85

1.28

0.67^g

90-day bleeding/embolism/thrombosis^a

0.87

0.68

1.13

0.30^g

90-day renal^a

0.92

0.77

1.11

0.38^g

Discharge to higher level of care^b

1.46

1.16

1.82

0.001^g

Discharge to home^c

0.71

0.56

0.88

0.002^g

30-day readmission^a

1.00

0.81

1.24

1.00^g

90-day readmission^a

1.08

0.88

1.32

0.48^g

Hospital length of stay^e

–0.61

–1.11

–0.10

0.02

Home-time ratio^{d, e}

–3.16

–6.76

0.45

0.09

1-year mortality^f

1.12

1.04

1.22

0.003