Duijndam Stefanie, Denollet Johan, Nyklíček Ivan, Kupper Nina
Department of Medical and Clinical Psychology, CoRPS-Centre of Research on Psychological and Somatic Diseases, Tilburg University, Tilburg, the Netherlands.
Int J Behav Med. 2017 Aug;24(4):552-562. doi: 10.1007/s12529-016-9624-1.
Percutaneous coronary intervention (PCI) is a common invasive procedure for the treatment of coronary artery diseases. Long-term cognitive functioning after PCI and its association with health-related quality of life (HRQL) and psychological factors is relatively unknown. The aim of this study is to examine whether perceived cognitive functioning during the year after PCI is associated with HRQL over this time period, and whether mood, fatigue, and age are associated with changes in perceived cognition and HRQL.
Patients undergoing PCI (n = 384, 79% male, mean age = 63, SD = 10) were recruited in the observational Tilburg Health Outcome Registry of Emotional Stress after Coronary Intervention (THORESCI) cohort study. Perceived concentration and attention problems, HRQL, mood, and fatigue were assessed at baseline, at 1-month and 12-month follow-up.
General linear mixed modeling analysis showed that across time, between- and within-subject differences in perceived concentration problems were associated with a reduced HRQL in all domains independent of clinical and demographic covariates. Only a part of this association could be explained by negative mood, fatigue, and older age. Similar findings were found for between-subject differences in perceived attention problems.
Between-subject differences and within-subject changes in perceived cognition in PCI patients were strongly associated with HRQL across time, such that poorer perceived cognition was associated with poorer HRQL, independent of demographic and clinical variables. Most of the associations were also independent of mood and fatigue. The results should increase the awareness of clinicians for the role of cognition in the cardiac rehabilitation and recovery post-PCI.
经皮冠状动脉介入治疗（PCI）是治疗冠状动脉疾病的一种常见侵入性手术。PCI术后的长期认知功能及其与健康相关生活质量（HRQL）和心理因素的关联相对尚不明确。本研究的目的是检验PCI术后一年内感知到的认知功能是否与这段时间内的HRQL相关，以及情绪、疲劳和年龄是否与感知认知和HRQL的变化相关。
在冠状动脉介入术后情绪应激的蒂尔堡健康结局登记（THORESCI）队列研究中招募接受PCI的患者（n = 384，79%为男性，平均年龄 = 63岁，标准差 = 10）。在基线、1个月和12个月随访时评估感知到的注意力不集中问题、HRQL、情绪和疲劳情况。
广义线性混合模型分析显示，随着时间推移，无论临床和人口统计学协变量如何，感知到的注意力不集中问题的组间和组内差异均与所有领域HRQL降低相关。这种关联只有一部分可由负面情绪、疲劳和年龄较大来解释。在感知到的注意力问题的组间差异方面也发现了类似结果。
PCI患者感知认知的组间差异和组内变化在整个时间段内与HRQL密切相关，即较差的感知认知与较差的HRQL相关，且独立于人口统计学和临床变量。大多数关联也独立于情绪和疲劳。这些结果应提高临床医生对认知在PCI后心脏康复和恢复中作用的认识。
