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DOI: 10.1055/s-0031-1297459
Post-interventional cognitive dysfunction and ischemic brain lesions after cardiac catheter procedures and CABG
Objectives: Post-interventional cognitive dysfunction (PICD) is a known and frequent complication of coronary artery bypass grafting (CABG). Although it is widely assumed that cardiac catheter procedures are of low-risk regarding neuropsychological side-effects, it is largely unknown, whether PICD occurs after percutaneus coronary intervention (PCI). Only a few studies have focused on a possibly specific risk for cerebral lesions or PICD in cardiac catheter interventions. The present study was conducted to contrast neuropsychological outcome, post-procedural ischemic brain lesion rates, depression/anxiety and health-related quality of life (HQL) in patients who underwent CABG or cardiac catheter interventions.
Methods: Neuropsychological data were obtained from 117 participants (37 patients with PCI, 47 patients with elective CABG) at baseline and 3 months post-interventional. The outcomes were contrasted to 33 healthy volunteers, using analysis of covariance with baseline scores as covariates.
Examination of four main cognitive domains (attention, executive function, visual and verbal memory) was performed using a battery of 10 well-established neuropsychological tests. Furthermore, Depression and anxiety were scored by the Hospital-Anxiety and Depression-scale. Health related quality of life (HQL) was scored using SF36 questionnaire.
Cranial magnetic resonance imaging (MRI) with diffusion-weighted sequences (DWI) was performed 2–4 days after the procedures.
Results: PICD was detected in 2 (of 10) tests in the catheter group as compared to the healthy controls (verbal memory: total recall, t=-2.61 (p=.005) and nonverbal memory, t=-2.60 (p=.005)). The CABG group showed PICD in 7 of 10 tests as compared to the healthy controls (statistics ranging from t=-1.95 (p=.027) to t=-5.14 (p< .001)). Scores of depression/anxiety and health-related quality of life were not associated with PICD (>.05).
MRI was carried out in 30 catheter and 39 CABG patients. The rate of acute ischemic lesions amounted to 3.3% in the catheter group and to 17.9% in the CABG group. The presence of ischemic lesions correlated with cognitive decline in 3 tests: pictorial memory (delayed recall and retrieval) and verbal memory (total recall).
Conclusions: As compared to CABG, PICD and cerebral lesions and PICD appear to be substantially milder after coronary catheter intervention, but not negligible.