Association of Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention With Memory Decline in Older Adults Undergoing Coronary Revascularization

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Abstract
Quiz Ref ID Postoperative neurocognitive disorder (NCD), formerly called postoperative cognitive decline, is a concern for older adults after coronary artery bypass grafting (CABG). In 2001, an observational study showed that 5 years after CABG, 42% of patients had demonstrable cognitive decline, considerably greater than in a comparison cohort of Medicare beneficiaries.1 Partly motivated by the hypothesis that exposure to a cardiopulmonary bypass pump during CABG causes adverse neurologic outcomes,2,3 off-pump CABG was developed in the late 1990s.4,5 Although randomized trials of on- vs off-pump CABG have shown no short- (1 year)5-7 or intermediate- (5 years)8 term cognitive benefit of off-pump CABG, these trials were small and had restrictive enrollment criteria. To date, there is no conclusive evidence on whether CABG in older adults causes a meaningful deterioration from patients’ presurgical cognitive trajectory and whether off-pump CABG avoids such adverse cognitive effects.

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