title: Management of Acute Myocardial Infarction in Patients With Dementia: Data From SveDem, the Swedish Dementia Registry.
abstract: We aimed to (1) study factors that determine the use of invasive procedures in the management of acute myocardial infarction (AMI) in patients with dementia and (2) determine whether the use of invasive procedures was associated with their better survival.
  
  
  
  Cohort study based on patients registered in the Swedish Dementia Registry (SveDem), 2007-2012. Median follow-up time was 228 days.
  
  
  
  Patients diagnosed with dementia in specialist memory clinics and primary care units in Sweden.
  
  
  
  A total of 525 patients with dementia who suffered AMI (mean age 89 years, 54% women).
  
  
  
  Information on AMI and use of invasive procedures (coronary angiography and percutaneous coronary intervention) was obtained from Swedish national health registers. Binary logistic regression was applied to study associations of patients' characteristics with the use of invasive procedures; odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Survival was analyzed with Kaplan-Meier curves; log-rank test was used to compare survival of patients who received an invasive procedure versus those who did not receive it. Cox regression was applied to study association of the invasive procedures with all-cause mortality; hazard ratios (HRs) with 95% CIs were calculated.
  
  
  
  One hundred ten patients (21%) with dementia received an invasive procedure in the management of AMI. After multivariate adjustment, lower age and higher global cognitive status were associated with the use of invasive procedures. The invasively managed patients survived longer (P = .001). The use of invasive procedures was associated with a lower risk of all-cause mortality, adjusting for type of AMI and dementia disorder, age, gender, registration unit, history of AMI and comorbidity score (HR 0.35, 95% CI 0.21-0.59), or total number of drugs (HR 0.34, 95% CI 0.20-0.58).
  
  
  
  Age and cognitive status determine the use of invasive procedures in patients with dementia. This study suggests that the invasive management of AMI has a benefit for survival of patients with dementia.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden; International Clinical Research Center and St. Anne's University Hospital, Brno, Czech Republic.
authors.forename: Pavla
authors.initials: P
authors.lastname: Cermakova
authors.affiliation: Department of Medicine, Huddinge, Section of Cardiology, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Karolina
authors.initials: K
authors.lastname: Szummer
authors.affiliation: Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Johnell
authors.affiliation: Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Fastbom
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Winblad
authors.affiliation: Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Eriksdotter
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden. Electronic address: dorota.religa@ki.se.
authors.forename: Dorota
authors.initials: D
authors.lastname: Religa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003704:Dementia; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D013548:Sweden
keywords: Acute myocardial infarction; coronary angiography; dementia; percutaneous coronary intervention; survival