Denollet J, Pedersen S S, Daemen J, de Jaegere P, Serruys P W, van Domburg R T
CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
J Intern Med. 2008 Feb;263(2):203-11. doi: 10.1111/j.1365-2796.2007.01870.x. Epub 2007 Dec 5.
Emotional distress has been related to clinical events in patients with coronary artery disease, but the influence of positive affect (i.e. mood states such as activity, joy and cheerfulness) has received little attention. Therefore, we wanted to investigate the role of positive affect on clinical outcome after percutaneous coronary intervention (PCI) with stent implantation in these patients.
Prospective follow-up study. At baseline, patients from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry completed measures of positive affect, depression and anxiety post-PCI. Patients with reduced positive affect scored 1 SD below the mean score.
University Hospital; Thoraxcenter of the Department of Cardiology.
874 patients (72% men; 62.2 +/- 10.9 years) from the RESEARCH registry. Main outcome measure. Death or myocardial infarction (MI) 2 years post-PCI.
At follow-up, there were 52 clinical events (deaths n = 27, MIs n = 25). Reduced positive affect and depression/anxiety were associated with poor prognosis, but reduced positive affect was the only independent predictor of events. The incidence of death/MI in adequate versus reduced positive affect patients was 4% (29/663) vs. 11% (23/211); HR = 2.55 (95% CI 1.46-4.34, P = 0.001), adjusting for clinical variables. Reduced positive affect and diabetes were independent prognostic factors, and patients with one (HR = 2.84, 95% CI 1.58-5.10) or both (HR = 5.61, 95% CI 2.25-13.99) of these factors had a higher risk when compared with nondiabetic patients with adequate positive affect, P < or = 0.003.
Reduced positive affect independently predicted death/MI following stent implantation, and improved risk stratification above and beyond diabetes.
情绪困扰与冠状动脉疾病患者的临床事件有关，但积极情绪（如活力、喜悦和愉悦等情绪状态）的影响却很少受到关注。因此，我们想研究积极情绪对这些患者经皮冠状动脉介入治疗（PCI）并植入支架后临床结局的作用。
前瞻性随访研究。在基线时，来自鹿特丹心脏病医院雷帕霉素洗脱支架评估（RESEARCH）注册研究的患者完成了PCI后积极情绪、抑郁和焦虑的测量。积极情绪降低的患者得分比平均得分低1个标准差。
大学医院；心脏病学系胸科中心。
来自RESEARCH注册研究的874例患者（72%为男性；年龄62.2±10.9岁）。主要结局指标：PCI后2年的死亡或心肌梗死（MI）。
随访时，发生了52例临床事件（死亡27例，MI 25例）。积极情绪降低和抑郁/焦虑与预后不良有关，但积极情绪降低是事件的唯一独立预测因素。积极情绪充足与降低的患者中死亡/MI的发生率分别为4%（29/663）和11%（23/211）；调整临床变量后，风险比（HR）=2.55（95%可信区间1.46 - 4.34，P = 0.001）。积极情绪降低和糖尿病是独立的预后因素，与积极情绪充足的非糖尿病患者相比，有其中一个因素（HR = 2.84，95%可信区间1.58 - 5.10）或两个因素（HR = 5.61，95%可信区间2.25 - 13.99）的患者风险更高，P≤0.003。
积极情绪降低独立预测支架植入后的死亡/MI，并且在糖尿病之外改善了风险分层。
