Clinical and prognostic implications of delirium in elderly patients with non-ST-segment elevation acute coronary syndromes
Vives-Borrás, Miquel (Institut d'Investigació Biomèdica Sant Pau)
Martínez-Sellés, Manuel (Hospital General Universitario Gregorio Marañón)
Ariza-Solé, Albert (Hospital Universitari de Bellvitge)
Vidán, María T. (Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM))
Formiga, Francesc (Hospital Universitari de Bellvitge)
Bueno, Héctor (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Sanchís, Juan (Hospital Clínic Universitari (València))
Alegre, Oriol (Hospital Universitari de Bellvitge)
Durán-Cambra, Albert (Institut d'Investigació Biomèdica Sant Pau)
López-Palop, Ramón (Hospital Universitario San Juan de Alicante)
Abu-Assi, Emad (Hospital Álvaro Cunqueiro (Vigo))
Sionis, Alessandro (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	Elderly patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) may present delirium but its clinical relevance is unknown. This study aimed at determining the clinical associated factors, and prognostic implications of delirium in old-aged patients admitted for NSTE-ACS. LONGEVO-SCA is a prospective multicenter registry including unselected patients with NSTE-ACS aged ≥ 80 years. Clinical variables and a complete geriatric evaluation were assessed during hospitalization. The association between delirium and 6-month mortality was assessed by a Cox regression model weighted for a propensity score including the potential confounding variables. We also analysed its association with 6-month bleeding and cognitive or functional decline. Among 527 patients included, thirty-seven (7%) patients presented delirium during the hospitalization. Delirium was more frequent in patients with dementia or depression and in those from nursing homes (27. 0% vs. 3. 1%, 24. 3% vs. 11. 6%, and 11. 1% vs. 2. 2%, respectively; all P < 0. 05). Delirium was significantly associated with in-hospital infections (27. 0% vs. 5. 3%, P < 0. 001) and usage of diuretics (70. 3% vs. 49. 8%, P = 0. 02). Patients with delirium had longer hospitalizations [median 8. 5 (5. 5-14) vs. 6. 0 (4. 0-10) days, P = 0. 02] and higher incidence of 6-month bleeding and mortality (32. 3% vs. 10. 0% and 24. 3% vs. 10. 8%, respectively; both P < 0. 05) but similar cognitive or functional decline. Delirium was independently associated with 6-month mortality (HR = 1. 47, 95% CI: 1. 02-2. 13, P = 0. 04) and 6-month bleeding events (OR = 2. 87; 95% CI: 1. 98-4. 16, P < 0. 01). In-hospital delirium in elderly patients with NSTE-ACS is associated with some preventable risk factors and it is an independent predictor of 6-month mortality.
Nota:	Altres ajuts: This study was supported by the funding from the Spanish Society of Cardiology.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra, i la creació d'obres derivades, sempre que no sigui amb finalitats comercials i que es distribueixin sota la mateixa llicència que regula l'obra original. Cal que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Acute coronary syndromes ; Delirium ; Prognosis ; The elderly
Publicat a:	Journal of Geriatric Cardiology : JGC, Vol. 16 (february 2019) , p. 121-128

Adreça original: https://www.jgc301.com/en/article/doi/10.11909/j.issn.1671-5411.2019.02.008
DOI: 10.11909/j.issn.1671-5411.2019.02.008
PMID: 30923543

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