Perski A, Feleke E, Anderson G, Samad B A, Westerlund H, Ericsson C G, Rehnqvist N
Division of Preventive Medicine, Karolinska Institute, Söder Hospital, Stockholm, Sweden.
Am Heart J. 1998 Sep;136(3):510-7. doi: 10.1016/s0002-8703(98)70229-7.
The inclusion of large, heterogeneous groups of patients for coronary bypass grafting (CABG) surgery has resulted in a more mixed treatment outcome. Thus it becomes important to identify patients who are less likely to benefit from surgery or who may require additional support to improve treatment outcome. The aim of the present study was to examine whether psychological status measured before CABG can contribute to prediction of short- and long-term outcomes of the surgery.
One hundred seventy-one consecutive patients from two large university hospitals in Stockholm completed a psychosocial questionnaire before being scheduled for surgery. One year after CABG, patients again completed the questionnaire. Follow-up of medical charts was conducted during the first 3 years after surgery. All major cardiac events (cardiac death, definite myocardial infarction, revascularization, and unstable angina verified by angiography or myocardial scintigraphy) were recorded. Although the overall effect of surgery was excellent in the majority of cases, the patients exhibiting a high degree of distress (anxiety, depression, and tiredness) before surgery assessed their status as being much worse both before the operation and at the 1-year follow-up. Equally important was the fact that patients considered distressed before surgery had significantly higher rates of cardiac events (16%) in the 3-year follow-up period compared with nondistressed patients (5%) (chi-square=5.11, degrees of freedom=1, p < 0.02).
Systematic evaluation and treatment of emotional distress in the candidates for coronary revascularization may be expected to result in more optimal subjective results and a reduction in the number of serious cardiac events after surgery.
将大量异质性患者纳入冠状动脉旁路移植术（CABG）手术导致治疗结果更加参差不齐。因此，识别那些不太可能从手术中获益或可能需要额外支持以改善治疗结果的患者变得很重要。本研究的目的是检查冠状动脉旁路移植术前测量的心理状态是否有助于预测手术的短期和长期结果。
来自斯德哥尔摩两家大型大学医院的171例连续患者在安排手术前完成了一份社会心理问卷。冠状动脉旁路移植术后1年，患者再次完成该问卷。在术后的前3年对病历进行随访。记录所有主要心脏事件（心源性死亡、明确的心肌梗死、血运重建以及经血管造影或心肌闪烁显像证实的不稳定型心绞痛）。尽管在大多数情况下手术的总体效果极佳，但术前表现出高度痛苦（焦虑、抑郁和疲劳）的患者在手术前和1年随访时均认为自己的状况要差得多。同样重要的是，术前被认为痛苦的患者在3年随访期内心脏事件发生率（16%）显著高于无痛苦患者（5%）（卡方检验=5.11，自由度=1，p<0.02）。
对冠状动脉血运重建术候选患者的情绪困扰进行系统评估和治疗，有望带来更优的主观结果，并减少术后严重心脏事件的数量。
