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Factors associated with intensive care unit delirium in patients with acute myocardial infarction

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Abstract

Some patients admitted to intensive care units (ICU) would develop delirium, which is associated with poor prognosis. The purpose of this retrospective study was to identify factors associated with ICU delirium in patients with acute myocardial infarction (AMI). We included 753 AMI and divided those into the ICU-delirium group (n = 110) and the non-ICU-delirium group (n = 643) according to the presence of ICU delirium. The ICU delirium was evaluated by confusion assessment method for the intensive care unit. Patient characteristics and clinical outcomes were compared between the 2 groups, and factors associated with ICU delirium were sought by multivariate analysis. The prevalence of female sex was significantly higher in the ICU-delirium group (43.6%) than in the non-ICU-delirium group (20.2%) (p < 0.001). The incidence of in-hospital death was significantly higher in the ICU-delirium group (17.3%) than in the non-ICU-delirium group (0.5%) (p < 0.001). The multivariate logistic regression analysis revealed that age [every 10 years increase: odds ratio (OR) 1.439, 95% confidence interval (CI) 1.127–1.837, p = 0.004], female sex (OR 2.237, 95%CI 1.300–3.849, p = 0.004), triple vessel disease (OR 2.317, 95%CI 1.365–3.932, p = 0.002), body mass index < 18.5 kg/m2 (OR 2.910, 95%CI 1.410–6.008, p = 0.004), use of mechanical support (OR 2.812, 95%CI 1.500–5.270, p = 0.001), respiratory failure (OR 5.342, 95%CI 3.080–9.265, p < 0.001), and use of continuous renal replacement therapy (OR 5.901, 95%CI 2.520–13.819, p < 0.001) were significantly associated with ICU delirium. In conclusion, ICU delirium was associated with in-hospital death. Older age, female sex, triple vessel disease, leanness, use of mechanical support, respiratory failure, and continuous renal replacement therapy were significantly associated with the occurrence of ICU delirium.

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Abbreviations

AMI:

Acute myocardial infarction

PCI:

Percutaneous coronary intervention

ICU:

Intensive care unit

CAM-ICU:

Confusion assessment method for the intensive care unit

References

  1. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH, Capewell S (2007) Explaining the decrease in U.S. deaths from coronary disease. N Engl J Med 356(23):2388–2398

    Article  CAS  PubMed  Google Scholar 

  2. Johansson S, Rosengren A, Young K, Jennings E (2017) Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord 17(1):53

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Despres JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB, American Heart Association Statistics C, Stroke Statistics S (2015) Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation 131(4):e29-322

    Google Scholar 

  4. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimsky P, Group ESCSD (2018) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European society of cardiology (ESC). Eur Heart J 39(2):119–177

    Article  Google Scholar 

  5. Miki R, Takeuchi M, Imai T, Seki T, Tanaka S, Nakamura M, Kawakami K (2019) Association of intensive care unit admission and mortality in patients with acute myocardial infarction. J Cardiol 74(2):109–115

    Article  PubMed  Google Scholar 

  6. Ozaki Y, Hara H, Onuma Y, Katagiri Y, Amano T, Kobayashi Y, Muramatsu T, Ishii H, Kozuma K, Tanaka N, Matsuo H, Uemura S, Kadota K, Hikichi Y, Tsujita K, Ako J, Nakagawa Y, Morino Y, Hamanaka I, Shiode N, Shite J, Honye J, Matsubara T, Kawai K, Igarashi Y, Okamura A, Ogawa T, Shibata Y, Tsuji T, Yajima J, Iwabuchi K, Komatsu N, Sugano T, Yamaki M, Yamada S, Hirase H, Miyashita Y, Yoshimachi F, Kobayashi M, Aoki J, Oda H, Katahira Y, Ueda K, Nishino M, Nakao K, Michishita I, Ueno T, Inohara T, Kohsaka S, Ismail TF, Serruys PW, Nakamura M, Yokoi H, Ikari Y, Task Force on Primary Percutaneous Coronary Intervention of the Japanese Cardiovascular Interventional T (2022) CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022. Cardiovasc Interv Ther 37(1):1–34

    Article  PubMed  Google Scholar 

  7. Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekval TM, Spaulding C, Van Veldhuisen DJ, Group ESCSD (2015) ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the european society of cardiology (ESC). endorsed by: association for european paediatric and congenital cardiology (AEPC). Eur Heart J 36(41):2793–2867

    Google Scholar 

  8. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK (2003) Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 51(5):591–598

    Article  PubMed  Google Scholar 

  9. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291(14):1753–1762

    Article  CAS  PubMed  Google Scholar 

  10. Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, Shintani AK, Gordon SM, Canonico AE, Dittus RS, Bernard GR, Ely EW (2010) Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 38(7):1513–1520

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286(21):2703–2710

    Article  CAS  PubMed  Google Scholar 

  12. Sawano M, Yamaji K, Kohsaka S, Inohara T, Numasawa Y, Ando H, Iida O, Shinke T, Ishii H, Amano T (2020) Contemporary use and trends in percutaneous coronary intervention in Japan: an outline of the J-PCI registry. Cardiovasc Interv Ther 35(3):218–226

    Article  PubMed  PubMed Central  Google Scholar 

  13. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Executive Group on behalf of the Joint European Society of Cardiology /American College of Cardiology /American Heart Association /World Heart Federation Task Force for the Universal Definition of Myocardial I (2018) Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 72(18):2231–2264

    Article  Google Scholar 

  14. Ohashi J, Sakakura K, Sasaki W, Taniguchi Y, Kani K, Yamamoto K, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H (2021) Usefulness of 500-m walk electrocardiogram test on clinical outcomes in patients with ST-segment elevation myocardial infarction. Heart Vessels 36(1):48–57

    Article  PubMed  Google Scholar 

  15. Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Jinnouchi H, Tsukui T, Yamamoto K, Seguchi M, Wada H, Fujita H (2021) Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction. Sci Rep 11(1):21403

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Noguchi M, Sakakura K, Akashi N, Adachi Y, Watanabe Y, Taniguchi Y, Ibe T, Yamamoto K, Wada H, Momomura S-i, Fujita H (2019) The comparison of clinical outcomes between inferior ST-elevation myocardial infarction with right ventricular infarction versus without right ventricular infarction. Int Heart J 60(3):560–568

    Article  CAS  PubMed  Google Scholar 

  17. Hatori M, Sakakura K, Taniguchi Y, Jinnouchi H, Tsukui T, Yamamoto K, Seguchi M, Wada H, Fujita H (2021) Factors associated with in-hospital death in patients with killip class 3 acute myocardial infarction. Int Heart J 62(4):756–763

    Article  CAS  PubMed  Google Scholar 

  18. Ban S, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H (2021) Association of asymptomatic low ankle-brachial index with long-term clinical outcomes in patients after acute myocardial infarction. J Atheroscler Thromb 29(7):992–1000

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kobayashi S, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H (2022) Comparison of door-to-balloon time and in-hospital outcomes in patients with ST-elevation myocardial infarction between before versus after COVID-19 pandemic. Cardiovasc Interv Ther 37(4):641–650

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Gibson CM, de Lemos JA, Murphy SA, Marble SJ, McCabe CH, Cannon CP, Antman EM, Braunwald E, Group TS (2001) Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. Circulation 103(21):2550–2554

    Article  Google Scholar 

  21. Tsukui T, Sakakura K, Taniguchi Y, Yamamoto K, Seguchi M, Jinnouchi H, Wada H, Fujita H (2020) Factors associated with poor clinical outcomes of ST-elevation myocardial infarction in patients with door-to-balloon time <90 minutes. PLoS ONE 15(10):e0241251

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Akinwande M, Dikko H, Samson A (2015) Variance inflation factor: as a condition for the inclusion of suppressor variable (s) in regression analysis. Open J Stat 5:754–767

    Article  Google Scholar 

  23. Jackel M, Zotzmann V, Wengenmayer T, Duerschmied D, Biever PM, Spieler D, von Zur MC, Stachon P, Bode C, Staudacher DL (2021) Incidence and predictors of delirium on the intensive care unit after acute myocardial infarction, insight from a retrospective registry. Catheter Cardiovasc Interv 98(6):1072–1081

    Article  PubMed  Google Scholar 

  24. Uguz F, Kayrak M, Cicek E, Kayhan F, Ari H, Altunbas G (2010) Delirium following acute myocardial infarction: incidence, clinical profiles, and predictors. Perspect Psychiatr Care 46(2):135–142

    Article  PubMed  Google Scholar 

  25. Eriksson M, Samuelsson E, Gustafson Y, Aberg T, Engstrom KG (2002) Delirium after coronary bypass surgery evaluated by the organic brain syndrome protocol. Scand Cardiovasc J 36(4):250–255

    Article  PubMed  Google Scholar 

  26. Litaker D, Locala J, Franco K, Bronson DL, Tannous Z (2001) Preoperative risk factors for postoperative delirium. Gen Hosp Psychiatry 23(2):84–89

    Article  CAS  PubMed  Google Scholar 

  27. Ljubisavljevic V, Kelly B (2003) Risk factors for development of delirium among oncology patients. Gen Hosp Psychiatry 25(5):345–352

    Article  PubMed  Google Scholar 

  28. Shiiba M, Takei M, Nakatsuru M, Bukawa H, Yokoe H, Uzawa K, Tanzawa H (2009) Clinical observations of postoperative delirium after surgery for oral carcinoma. Int J Oral Maxillofac Surg 38(6):661–665

    Article  CAS  PubMed  Google Scholar 

  29. Fong TG, Bogardus ST Jr, Daftary A, Auerbach E, Blumenfeld H, Modur S, Leo-Summers L, Seibyl J, Inouye SK (2006) Cerebral perfusion changes in older delirious patients using 99mTc HMPAO SPECT. J Gerontol A Biol Sci Med Sci 61(12):1294–1299

    Article  PubMed  Google Scholar 

  30. Haggstrom L, Welschinger R, Caplan GA (2017) Functional neuroimaging offers insights into delirium pathophysiology: a systematic review. Australas J Ageing 36(3):186–192

    Article  PubMed  Google Scholar 

  31. Oh ES, Sieber FE, Leoutsakos JM, Inouye SK, Lee HB (2016) Sex differences in hip fracture surgery: preoperative risk factors for delirium and postoperative outcomes. J Am Geriatr Soc 64(8):1616–1621

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wang H, Guo X, Zhu X, Li Y, Jia Y, Zhang Z, Yuan S, Yan F (2021) Gender differences and postoperative delirium in adult patients undergoing cardiac valve surgery. Front Cardiovasc Med 8:751421

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bellelli G, Zambon A, Volpato S, Abete P, Bianchi L, Bo M, Cherubini A, Corica F, Di Bari M, Maggio M, Manca GM, Rizzo MR, Rossi A, Landi F, Investigators GG (2018) The association between delirium and sarcopenia in older adult patients admitted to acute geriatrics units: results from the GLISTEN multicenter observational study. Clin Nutr 37(5):1498–1504

    Article  PubMed  Google Scholar 

  34. Greaves D, Psaltis PJ, Davis DHJ, Ross TJ, Ghezzi ES, Lampit A, Smith AE, Keage HAD (2020) Risk factors for delirium and cognitive decline following coronary artery bypass grafting surgery: a systematic review and meta-analysis. J Am Heart Assoc 9(22):e017275

    Article  PubMed  PubMed Central  Google Scholar 

  35. Trzepacz PT, Franco JG, Meagher DJ, Lee Y, Kim JL, Kishi Y, Furlanetto LM, Negreiros D, Huang MC, Chen CH, Kean J, Leonard M (2018) Delirium phenotype by age and sex in a pooled data set of adult patients. J Neuropsychiatry Clin Neurosci 30(4):294–301

    Article  PubMed  Google Scholar 

  36. Nam SY, Jeon SW, Kwon YH, Kwon OK (2021) Sex difference of mortality by age and body mass index in gastric cancer. Dig Liver Dis 53(9):1185–1191

    Article  PubMed  Google Scholar 

  37. Elgendy IY, Wegermann ZK, Li S, Mahtta D, Grau-Sepulveda M, Smilowitz NR, Gulati M, Garratt KN, Wang TY, Jneid H (2022) Sex differences in management and outcomes of acute myocardial infarction patients presenting with cardiogenic shock. JACC Cardiovasc Interv 15(6):642–652

    Article  PubMed  Google Scholar 

  38. Matetic A, Shamkhani W, Rashid M, Volgman AS, Van Spall HGC, Coutinho T, Mehta LS, Sharma G, Parwani P, Mohamed MO, Mamas MA (2021) Trends of sex differences in clinical outcomes after myocardial infarction in the United States. CJC Open 3(12 Suppl):S19–S27

    Article  PubMed  PubMed Central  Google Scholar 

  39. Suzuki M, Nishihira K, Takegami M, Honda S, Kojima S, Takayama M, Sumiyoshi T, Ogawa H, Kimura K, Yasuda S, Investigators J (2020) Clinical profiles and outcomes in the treatment of acute myocardial infarction in Japan of aging society. Heart Vessels 35(12):1681–1688

    Article  PubMed  Google Scholar 

  40. Stehli J, Martin C, Brennan A, Dinh DT, Lefkovits J, Zaman S (2019) Sex differences persist in time to presentation, revascularization, and mortality in myocardial infarction treated with percutaneous coronary intervention. J Am Heart Assoc 8(10):e012161

    Article  PubMed  PubMed Central  Google Scholar 

  41. Deng X, Qin P, Lin Y, Tao H, Liu F, Lin X, Wang B, Bi Y (2022) The relationship between body mass index and postoperative delirium. Brain Behav 12(4):e2534

    Article  PubMed  PubMed Central  Google Scholar 

  42. Chen H, Mo L, Hu H, Ou Y, Luo J (2021) Risk factors of postoperative delirium after cardiac surgery: a meta-analysis. J Cardiothorac Surg 16(1):113

    Article  PubMed  PubMed Central  Google Scholar 

  43. Moerer O, Schmid A, Hofmann M, Herklotz A, Reinhart K, Werdan K, Schneider H, Burchardi H (2002) Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use. Intensive Care Med 28(10):1440–1446

    Article  PubMed  Google Scholar 

  44. Sogayar AM, Machado FR, Rea-Neto A, Dornas A, Grion CM, Lobo SM, Tura BR, Silva CL, Cal RG, Beer I, Michels V, Safi J, Kayath M, Silva E (2008) A multicentre, prospective study to evaluate costs of septic patients in Brazilian intensive care units. Pharmacoeconomics 26(5):425–434

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors acknowledge all staff in the catheter laboratory, cardiology units, and emergency and intensive care units in Saitama Medical Center, Jichi Medical University for their technical support in this study.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan

    Hitomi Aono-Setoguchi, Kenichi Sakakura, Hiroyuki Jinnouchi, Yousuke Taniguchi, Takunori Tsukui, Yusuke Watanabe, Kei Yamamoto, Masaru Seguchi, Hiroshi Wada & Hideo Fujita

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  1. Hitomi Aono-Setoguchi
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  2. Kenichi Sakakura
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  3. Hiroyuki Jinnouchi
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  4. Yousuke Taniguchi
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  5. Takunori Tsukui
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  6. Yusuke Watanabe
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  7. Kei Yamamoto
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  10. Hideo Fujita
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Correspondence to Kenichi Sakakura.

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Conflict of interests

Dr. Sakakura has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic Cardiovascular, Terumo, OrbusNeich, Japan Lifeline, Kaneka, and NIPRO. Dr. Jinnouchi has received speaking honoraria from Abbott Vascular. Prof. Fujita has served as a consultant for Mehergen Group Holdings, Inc.

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Aono-Setoguchi, H., Sakakura, K., Jinnouchi, H. et al. Factors associated with intensive care unit delirium in patients with acute myocardial infarction. Heart Vessels 38, 478–487 (2023). https://doi.org/10.1007/s00380-022-02200-1

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