Wang Jianlong, Li Tianle, Gu Yan, Su Bin, Wang Hui, Lai Chaohui, Liu Yingwu
The Third Central Clinical College of Tianjin Medical University, Tianjin, China.
J Thorac Dis. 2024 Oct 31;16(10):6849-6862. doi: 10.21037/jtd-24-576. Epub 2024 Oct 24.
Psychological distress, including anxiety and depression, is not only prevalent in patients with coronary heart disease (CHD) but can actually predict adverse clinical events. Therefore, the necessity of addressing psychological problems among patients with CHD to improve their treatment results is increasingly acknowledged. This study's objective was to examine the prognostic impact of anxiety and depression on major adverse cardiovascular events (MACEs) and physical function among patients with acute coronary syndrome (ACS).
A total of 978 patients admitted to our hospital from September 2021 to September 2022 and diagnosed with severe vascular lesions using coronary angiography were enrolled. According to their scores on the Hospital Anxiety and Depression Scale (HADS) and the Center for Epidemiologic Studies Depression Scale at admission, they were divided into two groups and four subgroups: an anxiety group, a non-anxiety group, a depression group, and a non-depression group. The participants' baseline information, clinical characteristics, coronary angiography findings, MACEs, and changes in physical functionality were compared.
There were statistically significant differences between the anxiety and depression groups in marital status, education level, history of diabetes, clinical diagnosis, cardiac troponin T (cTnI), B-type natriuretic peptide (BNP), coronary angiography, and synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. Logistic regression analysis showed that gender, education level, diabetes history, cTnI, and SYNTAX score were risk factors for anxiety, while education level, diabetes, and SYNTAX score were risk factors for depression. A Kaplan-Meier survival curve model was used to analyze survival rates in the anxiety and depression groups. Hierarchical regression analyses of anxiety and depression at baseline predicted significant declines in physical functionality.
Social support improved physical functionality and reduced the impact of psychological distress. Psychological state had the greatest long-term prognostic value in patients with CHD.
心理困扰，包括焦虑和抑郁，不仅在冠心病（CHD）患者中普遍存在，而且实际上可以预测不良临床事件。因此，越来越多的人认识到解决冠心病患者心理问题以改善其治疗效果的必要性。本研究的目的是探讨焦虑和抑郁对急性冠状动脉综合征（ACS）患者主要不良心血管事件（MACE）和身体功能的预后影响。
共纳入2021年9月至2022年9月入住我院并经冠状动脉造影诊断为严重血管病变的978例患者。根据他们入院时在医院焦虑抑郁量表（HADS）和流行病学研究中心抑郁量表上的得分，将他们分为两组和四个亚组：焦虑组、非焦虑组、抑郁组和非抑郁组。比较参与者的基线信息、临床特征、冠状动脉造影结果、MACE以及身体功能的变化。
焦虑组和抑郁组在婚姻状况、教育水平、糖尿病史、临床诊断、心肌肌钙蛋白T（cTnI）、B型利钠肽（BNP）、冠状动脉造影以及紫杉醇药物洗脱支架与心脏外科手术协同评分（SYNTAX）评分方面存在统计学显著差异。逻辑回归分析表明，性别、教育水平、糖尿病史、cTnI和SYNTAX评分是焦虑的危险因素，而教育水平、糖尿病和SYNTAX评分是抑郁的危险因素。采用Kaplan-Meier生存曲线模型分析焦虑组和抑郁组的生存率。对基线时的焦虑和抑郁进行分层回归分析预测身体功能会显著下降。
社会支持改善了身体功能并减少了心理困扰的影响。心理状态对冠心病患者具有最大的长期预后价值。
