Cognitive impairment in patients undergoing coronary angiography: a cross-sectional study

Abstract

Atherosclerotic cardiovascular disease (ASCVD) is closely associated with cognitive decline, yet cognitive function is not routinely assessed in patients undergoing coronary angiography. Given the complexity of diagnostic and therapeutic decision-making in coronary artery disease (CAD), unrecognized cognitive impairment may affect understanding of complex medical information and engagement with secondary prevention. We therefore evaluated the prevalence and severity of cognitive impairment in patients undergoing coronary angiography and investigated clinical and vascular factors associated with impaired cognitive performance. In this cross-sectional study, 500 consecutive patients undergoing coronary angiography at a tertiary care center were assessed using the Montreal Cognitive Assessment (MoCA). Cognitive impairment was defined as a MoCA score <26. Patients were stratified into newly diagnosed CAD (ND-CAD), established CAD (> 1 year), and No CAD. Associations between cognitive function, CAD presence and extent, and cardiovascular risk factors were analyzed using univariable and multivariable logistic regression. Corresponding linear regression analyses of continuous MoCA scores were performed as sensitivity analyses. Internal validation of the primary multivariable model was performed using bootstrap resampling and stratified 5-fold cross-validation. Cognitive impairment was present in 60.4% of patients and increased stepwise across groups: 26.5% in patients without CAD, 61.5% in ND-CAD, and 94% in established CAD (all p < 0.0001). MoCA scores declined with increasing extent of CAD. The most pronounced deficits were observed in visuospatial/executive function, attention, language, and memory. In the primary multivariable model, advanced age, lower educational level, coronary and polyvascular atherosclerotic disease, aortic stenosis, history of stroke, type 2 diabetes mellitus, smoking, higher body mass index, and elevated high-sensitivity C-reactive protein were significantly associated with cognitive impairment. The apparent AUC of the primary multivariable model was 0.9428 (95% CI 0.9238–0.9617), with an optimism-corrected AUC of 0.9328 after bootstrap validation. Cognitive impairment was highly prevalent in patients undergoing coronary angiography and was consistently associated with the presence and extent of coronary and systemic atherosclerotic disease. Cognitive impairment may be associated with challenges in disease understanding and adherence to secondary prevention strategies, although these implications were not directly assessed in this study. Routine cognitive assessment may be considered to support patient-centered cardiovascular care.