Shibeshi Woldecherkos A, Young-Xu Yinong, Blatt Charles M
Lown Cardiovascular Research Foundation, Brookline, Massachusetts, USA.
J Am Coll Cardiol. 2007 May 22;49(20):2021-7. doi: 10.1016/j.jacc.2007.03.007. Epub 2007 May 4.
This study examined the effect of anxiety on mortality and nonfatal myocardial infarction (MI) in patients with coronary artery disease (CAD).
Inconsistent data exist regarding the impact of anxiety on the prognosis of patients with CAD.
The authors conducted a prospective cohort study at an outpatient cardiology clinic of 516 patients with CAD (mean age 68 years at entry, 82% male) by administering the Kellner Symptom Questionnaire annually. The primary outcome was the composite of nonfatal MI or all-cause mortality.
During an average follow-up of 3.4 years, we documented 44 nonfatal MIs and 19 deaths. A high cumulative anxiety score was associated with an increased risk of nonfatal MI or death. Comparing the highest to lowest tertile of anxiety score, the age-adjusted hazard ratio was 1.97 (95% confidence interval 1.03 to 3.78, p = 0.04). In a multivariate Cox model after adjusting for age, gender, education, marital status, smoking, hypertension, diabetes mellitus, previous MI, body mass index, and total cholesterol, each unit increase in the cumulative mean anxiety score was associated with increased risk of nonfatal MI or total mortality; the hazard ratio was 1.06 (95% confidence interval 1.01 to 1.12, p = 0.02).
A high level of anxiety maintained after CAD diagnosis constitutes a strong risk of MI or death among patients with CAD.
本研究探讨焦虑对冠心病（CAD）患者死亡率和非致死性心肌梗死（MI）的影响。
关于焦虑对CAD患者预后的影响，现有数据并不一致。
作者在一家门诊心脏病诊所对516例CAD患者（入组时平均年龄68岁，82%为男性）进行了一项前瞻性队列研究，每年使用凯尔纳症状问卷进行评估。主要结局为非致死性MI或全因死亡率的综合指标。
在平均3.4年的随访期间，我们记录了44例非致死性MI和19例死亡病例。累积焦虑评分高与非致死性MI或死亡风险增加相关。将焦虑评分最高三分位数与最低三分位数进行比较，年龄调整后的风险比为1.97（95%置信区间1.03至3.78，p = 0.04）。在对年龄、性别、教育程度、婚姻状况、吸烟、高血压、糖尿病、既往MI、体重指数和总胆固醇进行调整后的多变量Cox模型中，累积平均焦虑评分每增加一个单位，与非致死性MI或总死亡率风险增加相关；风险比为1.06（95%置信区间1.01至1.12，p = 0.02）。
CAD诊断后持续存在的高度焦虑是CAD患者发生MI或死亡的强烈风险因素。
