In patients with multivessel CAD, dementia risk was similar after CABG or PCI at 5 years (8.7% vs 8.5%; HR 1.02; p=0.86), with no age interaction.
Does CABG compared to PCI affect long-term dementia risk in older patients with multi-vessel coronary artery disease?
Long-term dementia risks are comparable between CABG and PCI in older patients with multi-vessel coronary artery disease, suggesting cognitive decline is driven by underlying disease rather than procedural factors.
Absolute Event Rate: 0% vs 0%
Abstract Background Coronary artery disease (CAD) is increasing in aging populations, leading to increased use of revascularization procedures such as coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). However, the long-term cognitive effects of these procedures remain controversial. Previous studies have yielded conflicting results regarding dementia risk associated with CABG and PCI, rendering it unclear whether dementia risk is related to procedural factors or baseline cardiovascular pathology. Purpose This study aimed to compare long-term dementia risk in patients with multi-vessel CAD (MVCAD) undergoing CABG versus PCI. Methods Retrospective analysis of 12,540 eligible patients 65 years or older with multi-vessel disease from KP Northern California system who underwent a coronary revascularization procedure (CABG or PCI). Exclusion criteria included preexisting dementia, prior stroke, or incomplete follow-up. Propensity-score matching and inverse probability treatment weighting (IPTW) accounted for 32 demographic and clinical covariates. Dementia was defined by ICD-10 codes (F00-F03, G30) or the initiation of anti-dementia therapy. Cumulative incidence was estimated using Gray’s sub distribution hazard model, considering death as a competing risk. Sensitivity analyses excluded early-onset dementia (1-year post-procedure) and stratified by age (75 vs. ≤75). Results Among eligible patients, 1,115 who underwent CABG and 1,001 who underwent PCI patients were matched (median age 68 vs. 67; 32% female). The median follow-up was 3.8 years for CABG and 3.5 years for PCI. No significant difference in dementia incidence was observed between the groups (Gray’s p=0.925). At 1, 3, and 5 years, cumulative dementia rates for CABG and PCI were:• CABG: 1.2% (95% CI: 0.7–1.9), 4.3% (3.1–5.8), 8.7% (6.9–10.5) vs.• PCI: 1.1% (0.6–1.8), 4.1% (3.0–5.4), 8.5% (6.7–10.3) The sub-distribution hazard ratio for CABG vs. PCI: 1.02 (95% CI: 0.79–1.32; p=0.86). Competing mortality risks were comparable (5-year mortality: 14.1% CABG vs. 13.8% PCI; p=0.82). Age-stratified analysis revealed no interaction (p=0.64 for 75 vs. ≤75). Excluding early dementia cases (n=43) yielded consistent results (HR 0.98; 95% CI: 0.73–1.31). Conclusion In a large propensity-matched cohort with MVCAD, long-term dementia risks associated with CABG and PCI are comparable, regardless of age or baseline comorbidities. These findings contradict the assumption that revascularization procedures themselves accelerate cognitive decline, instead suggesting that common factors such as chronic cerebral hypoperfusion or microvascular injury due to systemic atherosclerosis, contribute to both CAD progression and dementia. Our findings highlight the importance of personalized cardiovascular risk management strategies over procedural selection when advising patients about cognitive outcomes.Dementia rates PCI vs CABG
Shin et al. (Sat,) reported a other. In patients with multivessel CAD, dementia risk was similar after CABG or PCI at 5 years (8.7% vs 8.5%; HR 1.02; p=0.86), with no age interaction.