心肌梗死或心绞痛住院患者的心理困扰与冠状动脉造影及血运重建术的变化关系。

Variation in coronary angiography and revascularisation procedures in relation to psychological distress among patients admitted to hospital with myocardial infarction or angina.

机构信息

National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia.

Sunshine Coast University Hospital, Australia; Griffith University, Australia.

出版信息

J Psychosom Res. 2019 Oct;125:109794. doi: 10.1016/j.jpsychores.2019.109794. Epub 2019 Aug 10.

DOI:10.1016/j.jpsychores.2019.109794

PMID:31445320

Abstract

OBJECTIVE

Cardiac patients with psychological distress have a poorer prognosis than patients without distress; which may in part reflect differences in treatment. We quantified variation in coronary angiography and revascularisation procedures according to psychological distress among patients admitted with incident acute myocardial infarction (AMI) or angina.

METHODS

Questionnaire data (collected 2006-09) from 45 and Up Study participants were linked to hospitalisation and mortality data, to 30 June 2016. Among patients free from ischaemic heart disease at baseline and subsequently hospitalised with AMI or angina, Cox regression was used to model the association between distress (Kessler-10 scores: low [10-<12], mild [12-<16], moderate [16-<22] and high [22-50]) - assessed on the questionnaire - and coronary angiography and revascularisation procedures (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) within 30 days of admission, adjusting for personal characteristics, including physical functioning.

RESULTS

Proportions receiving angiography and PCI/CABG were 71.4% and 51.7% following AMI (n = 3749), and 61.3% and 31.3% for angina patients (n = 3772), respectively. Following AMI, age-sex-adjusted rates of PCI/CABG were lower with higher levels of distress (test for trend: p = .037), as were rates of angiography and PCI/CABG (p < .01) following admission with angina. After additional adjustment for personal characteristics, associations between distress and procedure rates attenuated substantively and were no longer significant, except that PCI/CABG rates remained lower among angina patients with high versus low distress (HR = 0.76, 95%CI: 0.59-0.99).

CONCLUSION

Distress-related variation in coronary procedures largely reflects differences in personal characteristics. Whether lower revascularisation rates among angina patients with high compared to low distress are clinically appropriate or represent under-treatment remains unclear.

摘要

目的

与无心理困扰的患者相比，有心理困扰的心脏病患者预后较差；这可能部分反映了治疗上的差异。我们根据患有急性心肌梗死（AMI）或心绞痛的患者的心理困扰程度，量化了冠状动脉造影和血运重建手术的差异。

方法

45 and Up 研究参与者的问卷调查数据（于 2006-09 年收集）与住院和死亡率数据相关联，截止至 2016 年 6 月 30 日。在基线时无缺血性心脏病且随后因 AMI 或心绞痛住院的患者中，使用 Cox 回归模型来评估问卷评估的困扰程度（Kessler-10 评分：低[10-<12]、轻度[12-<16]、中度[16-<22]和高[22-50]）与入院后 30 天内的冠状动脉造影和血运重建手术（经皮冠状动脉介入治疗 [PCI]或冠状动脉旁路移植术 [CABG]）之间的关联，调整个人特征，包括身体功能。

结果

AMI 后接受血管造影和 PCI/CABG 的比例分别为 71.4%和 51.7%（n=3749），心绞痛患者分别为 61.3%和 31.3%（n=3772）。AMI 后，随着困扰程度的增加，PCI/CABG 的年龄性别调整率降低（趋势检验：p=0.037），在因心绞痛入院后，血管造影和 PCI/CABG 的比例也降低（p<0.01）。在进一步调整个人特征后，困扰与手术率之间的关联实质性减弱，不再具有统计学意义，但心绞痛患者中，高困扰与低困扰相比，PCI/CABG 的比例仍然较低（HR=0.76，95%CI：0.59-0.99）。