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Coronary heart disease has achieved remarkable results in the prevention and treatment, but it still remains one of the major diseases threatening human health. With the rapid development of an economy, the accelerated pace of people's life and the increase of mental stress, the incidence of coronary heart disease comorbid emotional disorders is higher and higher, and at the same time, cardiologists take more and more attention to this phenomenon. A large number of studies have confirmed that depression/anxiety has become an independent risk factor for coronary heart disease, and also has an impact on the morbidity, development, and prognosis of coronary heart disease (CHD). With the continuous development and progress of medicine, in addition to traditional medicine treatment, percutaneous coronary intervention (PCI) has become a commonly used method for diagnosis and treatment of coronary heart disease. Although percutaneous coronary intervention as a minimally invasive treatment method is widely used in clinical practice, it still has a certain psychological impact on patients with coronary heart disease. After accepting coronary intervention treatment, patients with coronary heart disease often have different levels of affective disorder, especially in the economically less developed area and low level of the educational region. The affective disorder may be expressed as depression, anxiety, or even both exist at the same time, so as to affect the effect of surgical treatment for patients and seriously affect the patient’s quality of life, and the patients can’t return to society. So more and more cardiologists begin to pay attention to the psychological status of the patients with coronary heart disease while treating the disease itself. Patients with depression/anxiety should be given certain psychological intervention, which has an important significance for the rehabilitation and prognosis of patients with coronary heart disease.
This study was to explore the difference of depression and anxiety between single and multiple lesions after receiving percutaneous coronary intervention and its clinical outcomes.
The study population comprised a consecutive series of 289 patients treated with PCI in the hospital. According to the results of coronary angiography, the patients were divided into single vessel disease group (171 cases) and multivessel disease group (118 cases). Anxiety and depression levels in both groups of patients at one-week post-PCI were measured by Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety rating table (HAMA). Patients were followed up for 6 months after discharge. The endpoint was defined as myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia and mortality due to cardiac causes.
1. No significant differences were found for age, sex, diabetes mellitus, smoking, heart rate, blood lipid level (including total cholesterol, high-density lipoprotein, low-density lipoprotein), uric acid, creatine, left ventricular end diastolic diameter (LVED), New York heart association (NYHA) classification, acute myocardial infarction, and prior history of coronary artery stent implantation (Table 1, P>0.05). Statistical differences were found for hypertension and ejection fraction (EF, P<0.05).
2. The number of co-morbid depression for patients with coronary heart disease were 33 cases in single vessel disease group, accounting for 19%. And the number of co-morbid anxiety were 13 cases, accounting for 8%. There were no patients with moderate or severe depression/anxiety in single vessel disease group. The average score of depression was 5÷2, and the average score of anxiety was 4÷2. The number of co-morbid depression for patients with coronary heart disease was 39 cases in multivessel disease group, accounting for 33%. And the number of co-morbid anxiety was 27 cases, accounting for 23%. There was only one patient with moderate or severe depression (the score was 25) and two patients with moderate or severe anxiety (the score were 21 and 25, Table2) in multi-vessel disease group. The average score of depression was 7÷4, and an average score of anxiety was 5÷4. The difference was significant between the two groups (P<0.05). And the degree of depression and anxiety were more severe in the multivessel disease group than in the single vessel disease group (7÷4 vs 5÷2, 5÷4 vs 4÷2).
3. The incidence of recurrent cardiovascular events in single vessel disease group and multivessel disease group were 2.4% and 2.1% respectively. There was no statistical difference in the recurrence of cardiovascular events between single vessel disease group and multiple vessel disease group (Table3, P>0.05) at 6 months post-PCI.
1. Patients with coronary heart disease after percutaneous coronary intervention often appear affective disorders, such as depression/anxiety, but depression/anxiety is usually mild.
2. The degree of depression/anxiety of the patients after percutaneous coronary intervention in the multi-vessel disease group are more serious than those in the single vessel disease group.
3. The incidence of recurrent cardiovascular events in patients at 6 months post-PCI are low both in the multi and single vessel disease group, and there is no difference between the two groups.