Article

Previous studies in post-myocardial infarction patients with heart
failure have documented that high anxiety levels are associated with increased
mortality. In this prospective study, we determined the impact of anxiety on
long-term event risk in stable coronary heart disease (CHD) patients treated with
percutaneous coronary interventions (PCIs). METHODS: A total of 470 patients
referred for PCI completed the Hospital Anxiety and Depression Scale (HADS)
before undergoing stent implantation. Over a five-year follow-up period, data on
survival, occurrence of major adverse cardiovascular events (MACEs) and repeat
revascularization were obtained from n = 462 participants (98.3%). RESULTS:
All-cause mortality rates differed significantly across the four quartiles of the
HADS anxiety subscale, the lowest number of deaths (1.9%) being seen in patients
with the highest HADS-A quartile (scores >/= 10) as compared to those in the
three lower quartiles (11.8%, odds ratio = 0.14, 95%-confidence interval (95%
CI): 0.03-0.60, p = 0.002). Cox regression models adjusted for a variety of
potential somatic and procedural confounders confirmed the results from the
univariate analyses (hazard ratio (HR) = 0.21, 95% CI: 0.05-0.91, p = 0.037).
There were also fewer MACEs in anxious patients as compared to non-anxious
subjects (HR = 0.34, 95% CI: 0.14-0.80, p = 0.014). In contrast, anxious patients
had a higher rate of repeat revascularization (26.4% versus 16.6%, p = 0.033).
CONCLUSIONS: In CHD patients undergoing elective PCI, higher anxiety levels are
positively associated with survival and reduce the risk for MACE during the first
five years after index PCI. The beneficial effects of anxiety on cardiovascular
mortality and morbidity suggest that a differentiated approach to diagnosing and
treating anxiety in CHD patients is warranted.
CI - (c) The European Society of Cardiology 2013 Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav.

Langue : ANGLAIS