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Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting.
Eur J Prev Cardiol. 2015 Jan; 22(1):75-82.EJ

Abstract

OBJECTIVE

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.

Authors+Show Affiliations

Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Germany.Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Germany.Cardiological Practice, Heart Center Bremen, Germany.Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Germany cherrma@gwdg.de.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24045768

Citation

Meyer, Thomas, et al. "Anxiety Is Associated With a Reduction in Both Mortality and Major Adverse Cardiovascular Events Five Years After Coronary Stenting." European Journal of Preventive Cardiology, vol. 22, no. 1, 2015, pp. 75-82.
Meyer T, Hussein S, Lange HW, et al. Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. Eur J Prev Cardiol. 2015;22(1):75-82.
Meyer, T., Hussein, S., Lange, H. W., & Herrmann-Lingen, C. (2015). Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. European Journal of Preventive Cardiology, 22(1), 75-82. https://doi.org/10.1177/2047487313505244
Meyer T, et al. Anxiety Is Associated With a Reduction in Both Mortality and Major Adverse Cardiovascular Events Five Years After Coronary Stenting. Eur J Prev Cardiol. 2015;22(1):75-82. PubMed PMID: 24045768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. AU - Meyer,Thomas, AU - Hussein,Sharif, AU - Lange,Helmut W, AU - Herrmann-Lingen,Christoph, Y1 - 2013/09/17/ PY - 2013/9/19/entrez PY - 2013/9/21/pubmed PY - 2015/8/19/medline KW - Coronary heart disease KW - anxiety KW - mortality KW - prognosis SP - 75 EP - 82 JF - European journal of preventive cardiology JO - Eur J Prev Cardiol VL - 22 IS - 1 N2 - OBJECTIVE: 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. SN - 2047-4881 UR - https://www.unboundmedicine.com/medline/citation/24045768/Anxiety_is_associated_with_a_reduction_in_both_mortality_and_major_adverse_cardiovascular_events_five_years_after_coronary_stenting_ L2 - http://journals.sagepub.com/doi/full/10.1177/2047487313505244?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -