Does Coronary Angiography and Percutaneous Coronary Intervention Affect Cognitive Function?

      Cerebral microemboli are frequently observed during coronary angiography (CA) and percutaneous coronary intervention (PCI), and their numbers have been related to the vascular access site used. Although cerebral microemboli can cause silent cerebral lesions, their clinical impact is debated. To study this, 93 patients referred for CA or PCI underwent serial cognitive testing using the Montreal Cognitive Assessment (MoCA) test to detect postprocedural cognitive impairment. Patients were randomized to radial or femoral access. In a subgroup of 35 patients, the number of cerebral microemboli was monitored with transcranial Doppler technique. We found the median precatheterization result of the MoCA test to be 27, and it did not change significantly 4 and 31 days, respectively, after the procedure. There was no significant correlation between the number of cerebral microemboli and the difference between preprocedural and postprocedural MoCA tests. The test results did not differ between vascular access sites. One-third of the patients had a precatheterization median MoCA test result <26 corresponding to mild cognitive impairment. In conclusion, using the MoCA test, we could not detect any cognitive impairment after CA or PCI, and no significant correlations were found between the results of the MoCA test and cerebral microemboli or vascular access site, respectively. In patients with suspected coronary heart disease, mild cognitive impairment was common.
      To read this article in full you will need to make a payment


        • Lin J.S.
        • Connor E.
        • Rossom R.C.
        • Perdue L.A.
        • Eckstrom E.
        Screening for cognitive impairment in older adults: a systematic review for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2013; 159: 601-612
        • Nasreddine Z.S.
        • Phillips N.A.
        • Bedirian V.
        • Charbonneau S.
        • Whitehead V.
        • Collin I.
        • Cummings J.L.
        • Chertkow H.
        The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 695-699
      1. Mil J.W.F. Sweetman S.C. The Martindale, the Complete Dug Reference. 37th ed. The Pharmaceutical Press, London-Chicago2011: 876 (ISBN 978 0 85369 933 0. (Book review), 2011)
        • Brucher R.
        • Russell D.
        Automatic online embolus detection and artifact rejection with the first multifrequency transcranial Doppler.
        Stroke. 2002; 33: 1969-1974
        • Russell D.
        • Brucher R.
        Online automatic discrimination between solid and gaseous cerebral microemboli with the first multifrequency transcranial Doppler.
        Stroke. 2002; 33: 1975-1980
        • Hodges J.L.
        • Lehmann E.L.
        The efficiency of some nonparametric competitors of the t-test.
        Ann Math Stat. 1956; 27: 324-335
        • Langa K.M.
        • Levine D.A.
        The diagnosis and management of mild cognitive impairment: a clinical review.
        JAMA. 2014; 312: 2551-2561
        • Selnes O.A.
        • Grega M.A.
        • Borowicz Jr., L.M.
        • Royall R.M.
        • McKhann G.M.
        • Baumgartner W.A.
        Cognitive changes with coronary artery disease: a prospective study of coronary artery bypass graft patients and nonsurgical controls.
        Ann Thorac Surg. 2003; 75: 1377-1384
        • Roalf D.R.
        • Moberg P.J.
        • Xie S.X.
        • Wolk D.A.
        • Moelter S.T.
        • Arnold S.E.
        Comparative accuracies of two common screening instruments for classification of Alzheimer's disease, mild cognitive impairment, and healthy aging.
        Alzheimers Dement. 2013; 9: 529-537
        • Borowicz L.M.
        • Goldsborough M.A.
        • Selnes O.A.
        • McKhann G.M.
        Neuropsychologic change after cardiac surgery: a critical review.
        J Cardiothorac Vasc Anesth. 1996; 10: 105-111
        • Bhat G.
        • Yost G.
        • Mahoney E.
        Cognitive function and left ventricular assist device implantation.
        J Heart Lung Transplant. 2015; 34: 1398-1405
        • Cameron J.
        • Worrall-Carter L.
        • Page K.
        • Stewart S.
        • Ski C.F.
        Screening for mild cognitive impairment in patients with heart failure: Montreal cognitive assessment versus mini mental state exam.
        Eur J Cardiovasc Nurs. 2013; 12: 252-260
        • Ball J.
        • Carrington M.J.
        • Stewart S.
        Mild cognitive impairment in high-risk patients with chronic atrial fibrillation: a forgotten component of clinical management?.
        Heart. 2013; 99: 542-547
        • McLennan S.N.
        • Mathias J.L.
        • Brennan L.C.
        • Stewart S.
        Validity of the Montreal Cognitive Assessment (MoCA) as a screening test for mild cognitive impairment (MCI) in a cardiovascular population.
        J Geriatr Psychiatry Neurol. 2011; 24: 33-38
        • Lund C.
        • Nes R.B.
        • Ugelstad T.P.
        • Due-Tonnessen P.
        • Andersen R.
        • Hol P.K.
        • Brucher R.
        • Russell D.
        Cerebral emboli during left heart catheterization may cause acute brain injury.
        Eur Heart J. 2005; 26: 1269-1275
        • Jurga J.
        • Nyman J.
        • Tornvall P.
        • Mannila M.N.
        • Svenarud P.
        • van der Linden J.
        • Sarkar N.
        Cerebral microembolism during coronary angiography: a randomized comparison between femoral and radial arterial access.
        Stroke. 2011; 42: 1475-1477
        • Pacchioni A.
        • Versaci F.
        • Mugnolo A.
        • Penzo C.
        • Nikas D.
        • Sacca S.
        • Favero L.
        • Agostoni P.F.
        • Garami Z.
        • Prati F.
        • Reimers B.
        Risk of brain injury during diagnostic coronary angiography: comparison between right and left radial approach.
        Int J Cardiol. 2013; 167: 3021-3026
        • Petersen R.C.
        Clinical practice. Mild cognitive impairment.
        N Engl J Med. 2011; 364: 2227-2234
        • Plassman B.L.
        • Langa K.M.
        • Fisher G.G.
        • Heeringa S.G.
        • Weir D.R.
        • Ofstedal M.B.
        • Burke J.R.
        • Hurd M.D.
        • Potter G.G.
        • Rodgers W.L.
        • Steffens D.C.
        • McArdle J.J.
        • Willis R.J.
        • Wallace R.B.
        Prevalence of cognitive impairment without dementia in the United States.
        Ann Intern Med. 2008; 148: 427-434
        • Rosengart T.K.
        • Sweet J.
        • Finnin E.B.
        • Wolfe P.
        • Cashy J.
        • Hahn E.
        • Marymont J.
        • Sanborn T.
        Neurocognitive functioning in patients undergoing coronary artery bypass graft surgery or percutaneous coronary intervention: evidence of impairment before intervention compared with normal controls.
        Ann Thorac Surg. 2005; 80: 1327-1334
        • Swedeheart
        Annual Report 2014.
        (Stockholm)2015 (Available from:) (Accessed on January 11, 2016)
        • Chartier M.
        • Crouch P.C.
        • Tullis V.
        • Catella S.
        • Frawley E.
        • Filanosky C.
        • Carmody T.
        • McQuaid J.
        • Lampiris H.
        • Wong J.K.
        The Montreal Cognitive Assessment: a pilot study of a brief screening tool for mild and moderate cognitive impairment in HIV-positive veterans.
        J Int Assoc Provid AIDS Care. 2015; 14: 197-201