Pedersen Susanne S, Denollet Johan, Erdman Ruud A M, Serruys Patrick W, van Domburg Ron T
Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Room P506, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
J Behav Med. 2009 Jun;32(3):294-301. doi: 10.1007/s10865-009-9204-9. Epub 2009 Feb 7.
We examined the impact of co-occurring diabetes and hopelessness on 3-year prognosis in percutaneous coronary intervention patients. Consecutive patients (n = 534) treated with the paclitaxel-eluting stent completed a set of questionnaires at baseline and were followed up for 3-year adverse clinical events. The incidence of 3-year death/non-fatal myocardial infarction was 3.5% in patients with no risk factors (neither hopelessness nor diabetes), 8.2% in patients with diabetes, 11.2% in patients with high hopelessness, and 15.9% in patients with both factors (p = 0.001). Patients with hopelessness (HR: 3.28; 95% CI: 1.49-7.23) and co-occurring diabetes and hopelessness (HR: 4.89; 95% CI: 1.86-12.85) were at increased risk of 3-year adverse clinical events compared to patients with no risk factors, whereas patients with diabetes were at a clinically relevant but not statistically significant risk (HR: 2.40; 95% CI: 0.82-7.01). These results remained, adjusting for baseline characteristics and depressive symptoms. These findings testify to the importance of identifying patients with co-occurring risk factors, as they likely require special management in clinical practice in addition to standard medical treatment.
我们研究了糖尿病与绝望情绪并发对经皮冠状动脉介入治疗患者3年预后的影响。连续接受紫杉醇洗脱支架治疗的患者（n = 534）在基线时完成了一组问卷调查，并对3年不良临床事件进行了随访。无危险因素（既无绝望情绪也无糖尿病）的患者3年死亡/非致死性心肌梗死发生率为3.5%，糖尿病患者为8.2%，绝望情绪严重的患者为11.2%，两种因素并存的患者为15.9%（p = 0.001）。与无危险因素的患者相比，绝望情绪严重的患者（HR：3.28；95%CI：1.49 - 7.23）以及糖尿病与绝望情绪并发的患者（HR：4.89；95%CI：1.86 - 12.85）发生3年不良临床事件的风险增加，而糖尿病患者的风险具有临床相关性但无统计学意义（HR：2.40；95%CI：0.82 - 7.01）。在校正基线特征和抑郁症状后，这些结果依然成立。这些发现证明了识别具有并发危险因素患者的重要性，因为在临床实践中，除了标准医疗治疗外，他们可能还需要特殊管理。
