Spindler Helle, Pedersen Susanne S, Serruys Patrick W, Erdman Ruud A M, van Domburg Ron T
Department of Psychology, Aarhus University, Denmark.
J Affect Disord. 2007 Apr;99(1-3):173-9. doi: 10.1016/j.jad.2006.09.009. Epub 2006 Oct 13.
Anxiety is an often overlooked risk factor in coronary artery disease (CAD). Hence, little is known about predictors of unremitting chronic anxiety in CAD patients. We examined whether the distressed personality (type-D) predicts chronic anxiety post percutaneous coronary intervention (PCI).
Unselected patients (n=167) treated with PCI using sirolimus-eluting or bare metal stents as part of the RESEARCH registry, who were anxious 6 months post-PCI, qualified for inclusion. Patients completed the Hospital Anxiety and Depression Scale at 6 and 12 months and the Type-D Scale (DS14) 6 months post-PCI.
Of 167 patients anxious at 6 months, 108 (65%) were still anxious 12 months post-PCI. Significant univariable predictors of chronic anxiety were type-D personality (OR: 3.17; 95% CI: 1.64-6.14) and sirolimus-eluting stent implantation (OR: 0.51; 95% CI: 0.27-0.98), with sirolimus-eluting stent showing a protective effect. In multivariable analyses, type-D personality (OR: 3.31; 95% CI: 1.59-6.87) and sirolimus-eluting stent implantation (OR: 0.44; 95% CI: 0.21-0.92) remained significant independent predictors of chronic anxiety adjusting for depressive symptoms at 6 months, demographic and clinical risk factors.
All psychological measures were based on self-report, and we had no information on cardiac rehabilitation or use of pharmacotherapy; however our sample represented patients seen in daily clinical practice.
These findings suggest that type-D personality is a risk factor and sirolimus-eluting stent implantation a protective factor for the occurrence of chronic anxiety. The protective effect of sirolimus-eluting stents in relation to anxiety warrants replication in future studies.
焦虑是冠状动脉疾病（CAD）中一个常被忽视的危险因素。因此，对于CAD患者持续性慢性焦虑的预测因素知之甚少。我们研究了情绪困扰型人格（D型人格）是否能预测经皮冠状动脉介入治疗（PCI）后慢性焦虑的发生。
作为RESEARCH注册研究的一部分，未经过筛选的使用西罗莫司洗脱支架或裸金属支架进行PCI治疗的患者（n = 167）符合纳入标准，这些患者在PCI术后6个月时存在焦虑症状。患者在术后6个月和12个月完成医院焦虑抑郁量表评估，并在PCI术后6个月完成D型人格量表（DS14）评估。
在167例术后6个月时存在焦虑的患者中，108例（65%）在PCI术后12个月时仍存在焦虑。慢性焦虑的显著单变量预测因素为D型人格（比值比：3.17；95%置信区间：1.64 - 6.14）和西罗莫司洗脱支架植入（比值比：0.51；95%置信区间：0.27 - 0.98），西罗莫司洗脱支架显示出保护作用。在多变量分析中，调整术后6个月的抑郁症状、人口统计学和临床危险因素后，D型人格（比值比：3.31；95%置信区间：1.59 - 6.87）和西罗莫司洗脱支架植入（比值比：0.44；95%置信区间：0.21 - 0.92）仍然是慢性焦虑的显著独立预测因素。
所有心理测量均基于自我报告，且我们没有关于心脏康复或药物治疗使用情况的信息；然而，我们的样本代表了日常临床实践中所见的患者。
这些发现表明，D型人格是慢性焦虑发生的危险因素，而西罗莫司洗脱支架植入是慢性焦虑发生的保护因素。西罗莫司洗脱支架对焦虑的保护作用有待未来研究进一步验证。
