66 Cognitive impairment is not associated with 30 day major adverse cardiovascular events in older (75 years) patients presenting with non-st elevation acute coronary syndrome: an evaluation from the icon1 study
Bibliographic record
Abstract
Introduction Dementia is leading cause of death in the UK and shares many common risk factors with coronary artery disease. The relationship between cognition and major adverse cardiovascular events (MACE) in older patients presenting with non ST elevation Acute Coronary syndrome (NSTEACS) is not known. Aim To investigate the association of cognitive impairment with 30 day MACE (mortality, hospital readmission with ACS, unplanned revascularisation, stroke and major bleeding events) in older patients presenting with NSTEACS in the ICON1 study. Method Over a period of 34 months 277 patients 75 years of age, admitted for invasive management of NSTEACS, were enrolled into a multicentre prospective observational study. Cognitive assessment was performed by Montreal Cognitive Assessment (MoCA) test, where a cut-off of 26 is used to determine cognitive impairment. Frailty was assessed using the Fried criteria, where a score of 0 is robust, 1 or 2 is pre-frail and 3 is frail. Results 251 patients had a MoCA score calculated at presentation (mean±Standard deviation [SD]=25.1±3.3), nearly half of the patients (n=122, 48.6%) had cognitive impairment. The mean age was 81.2±4.0 years (mean± Standard Deviation [SD]). Patients with cognitive impairment were older compared to normal cognition group (82.2±3.9 vs. 80.2±3.9 years, p<0.001), and were frail (36.1% vs. 18.6%, p=0.002). Overall 19 (7.6%) patients reached MACE outcome, the rate of composite adverse outcomes were 6.6% vs. 8.5% (p=0.555) respectively. No patient died at 30 day in the selected cohort and no one had ST elevation myocardial infarction. There was no difference in the occurrence of non ST elevation myocardial infarction (0.8% vs. 0.8%), unstable angina (0.8% vs. 2.3%, p=0.808), unplanned revascularisation (1.6% vs. 1.6%, p=1.0), stroke/Transient Ischaemic Attack (0% vs. 0.8%, p=1.0), and major bleeding (4.1% vs. 3.9%, p=1.0), and readmission with ACS rate (1.6% vs. 3.1%, p=0.684) between the impaired and normal cognition groups respectively. Conclusion Cognitive impairment is common in patients over 75 years of age with NSTEACS managed invasively. Those with significant impairment are older and frail. Short-term 30 day MACE outcomes are not different between cognition groups in this selected cohort of patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".