| Objective:Coronary heart disease is a common disease which is serious hazard to human health, and as one of the psychosomatic disease is strongly associated with psychological and social psychological factors in the occurrence, development and rehabilitation, the prognosis and so on. Moreover, the consequences of angina and myocardial infarction with anxiety and depression are the most serious of all the types of coronary heart disease. Percutaneous coronary intervention is one of the main treatment methods of coronary heart disease, however, the current study of the relationship among percutaneous coronary intervention, anxiety and depression are less reported. Our study is aimed at the incidence of anxiety or depression in different time periods of percutaneous coronary intervention and the association with the anxiety, depression and surgical prognosis.Methods:We randomly selected clear diagnosis of coronary heart disease patients requireing percutaneous coronary intervention treatment from September 2013 and March 2014 in Cardiovascular internal medicine of the second hospital of Hebei Medical University in hospital by coronary angiography. We recorded selected patients’ baseline including: the status of age, gender, work location, educational level,marriage, children, smoking, drinking, exercise every day, diet, living state, Career, monthy income and reimbursement way. Past medical history: hypertension, diabetes, hyperlipidemia, cerebrovascular disease. Clinical indicators: 1. The diagnosis is angina or myocardial infarction, the existence of left main lesion, lesion blood vessel number, the blood vessels of stents, whether vascular treatment completely, intraoperative heparin dosage, the dosage of contrast agent.2. General Hospital and Anxiety Depression Scale, preoperative questionnaire, preoperative worry about problems, preoperative understanding of disease, understanding of the performer, the understanding of the operation, postoperative questionnaire, postoperative worry about problems.3. The auxiliary examination indexes included ejection fraction, blood routine, liver function, renal function, electrolyte, myocardial enzymes, troponin and blood coagulation routine. All patients complete HADS questionnaire, preoperative questionnaire, worrying about problems preoperative independently 1 day before coronary angiography. Whether we chosen PCI for treatment or not according to the results of coronary angiography and the decisions of family members. At the same time, the specific operation were decided by the performer depending on the situation. The patients with treatment of PCI Continued to fill in HADS questionnaire, postoperative questionnaire, worrying about problems postoperative independently 1 day after PCI and HADS questionnaire in postoperative 1 month, 3 months, 6 months and 12 months respectively.The corresponding indicators were detected in the whole process. Statistical analyses:We applied SPSS statistical analysis software, version 13.0 to analyze the data with measurement data described using mean + /- standard deviation( SX ±)and count data using percentage. Group differences between depression and non-depression or anxity and non-anxiety patients were examined using the Chi-square test for nominal variables and independent sample T-test for independent samples with normality data or nonparametric test with non- normality data for continuous variables. Different times of anxiety or depression prevalence were used the Chi-square test, orderly data of linear trend and multiple comparison to analyse the relationship between anxiety or depression as time chaning. Binary logistic regression analysis was performed to evaluate factors of the prevalence of anxiety and/or depression. All results were based on two-tailed tests, and a p-value<0.05 was used to indicate statistical significance.Results:1 The BaselineWe selected 170 patients followed up for twelve months. The preoperative anxiety group, 59 cases of patients, accounted for 34.70% with the age of 58.00(50.00 ~ 64.00), including 69.49% male(41 of 59), 27.12% myocardial infarction(16 of 59), 72.88% unstable angina(43 of 59).The preoperative depression group was 40 cases of patients accounting for 23.50% with the age of 58.5(50.24 ~ 64.75), including 60.00% male(24 of 40), 35.00% myocardial infarction(14 of 40), 65.00% unstable angina(26 of 40).With 74 cases of patients, the proportion of preoperative affective disorder group was 43.50% with the age of 58.00(50.00~64.00), including 67.57% male(50 of 74), 31.10% myocardial infarction(23 of 74), 68.90% unstable angina(51 of 74).The preoperative comorbidity of anxiety and depression group, about 25 cases of patients,accounted for 14.70% with the age of 58.00(50.00~64.00), including 60.00% male(15 of 25), 28.00% myocardial infarction(7 of 25), 72.00% unstable angina(18 of 25).2 Worrying about problems with the prevalence of anxiety or/and depression before and after percutaneous coronary interventionThe proportion of preoperative patients worrying about surgery failure,recurrence,heart function damage, surgery sequel, the irresponsible doctor, too much debt affecting life, caring not carefully, and social function to reduce, respectively was 46.4%(79 of 170), 40.59%(69 of 170), 33.53%(57 of 170), 31.18%(53 of 170), 11.80%(20 of 170), 15.88%(27 of 170), 11.18%(19 of 170)and 6.5%(11 of 170).Postoperative patients who worried about such problems as recurrence, surgery sequel, heart function damage, too much debt affecting life, caring not carefully, the irresponsible doctor accounted for 58.24%(99 of 170), 30.60%(52 of 170), 17.60%(30 of 170), 14.7%(25 of 170), 8.2%(14 of 170), 5.90%(10 of 170).3 The anxiety and/or depression prevalence of different indicators3.1 The anxiety and/or depression prevalence of different indicators one-day before PCIThe anxiety prevalence with different culture degrees, the reimbursement ways and concerning relatives degree of care, surgery sequel existed significant differences(P<0.05). The depression prevalence in different ways of working location, reimbursement, occupation, educational level, income, living condition, as well as whether worrying about caring not carefully, surgery failure, heart function damage, no one to take care of children or not played a statistical significantly difference(P<0.05). There was a significant difference of preoperative affective disorder prevalence among different working location, reimbursement, educational levels, income, levels of NE% and concerning caring not carefully,heart function damage, surgery sequel or not. There existed a significantly difference of comorbidity of anxiety and depression prevalence in different educational levels, income and worrying about surgery failure and heart function damage or not(P<0.05). The higher was the prevalence of anxiety, depression, affective disorder, comorbidity of anxiety and depression, the lower were preoperative questionnaire scores(P<0.05).3.2 The anxiety and/or depression prevalence of different indicators one-day after PCIThe prevalence of anxiety, depression, affective disorder, comorbidity of anxiety and depression was higher for patients worrying about postoperative heart function damage than those without these concerns(P<0.05).There was a significant difference of postoperative affective disorder prevalence with different levels of NE%(P<0.05). The postoperative questionnaire scores were lower with the prevalence of anxiety, depression, affective disorder, comorbidity of anxiety and depression elevating(P<0.05).3.3 The anxiety and/or depression prevalence of different indicators twelvemonths after PCIThe patients whose were telling doctors physical symptoms in twelve months after PCI had higher prevalence of anxiety, depression, affective disorder, comorbidity of anxiety and depression than those without physical symptoms(P<0.01).The prevalence of depression was lower for patients with drinking than these stoped drinking. The same to affective disorder prevalence(P<0.05).4 Binary logistic regression analysis for factors of the prevalence of anxiety and/or depression.According to binary logistic regression analysis, the higher educational levels-was the protective factor of anxiety(OR = 0.560, 95% CI 0.343 to-0.913), depression(OR = 0.342, 95%CI0.178 to 0.657) affective disorder-(OR = 0.441, 95%CI0.266 to 0.729) comorbidity of anxiety and depression-(OR =0.430, 95%CI0.211 to 0.877) one day before PCI. Worrying about surgery sequel was the risk factor of anxiety prevalence one day before PCI(OR =2.464, 95%CI0.343 to 0.913). The risk factor of preoperative affective disorder included concerning caring not careful and heart function damage(OR=4.031, 95%-CI1.138 to 12.327)(OR =3.113, 95%CI1.372 to 7.062). Concerning heart function damage became the risk factor of comorbidity of anxiety and depression one day before PCI(OR=3.724, 95%CI1.520 to 9.127).The risk factor of anxiety and co-moridity-of anxiety and depression(OR =2.673, 95%CI1.115 to 6.407)(OR =2.384, 95%CI1.051 to 5.407) one day after PCI was concerning heart function damage.Physical symptoms in twelve months after PCI became the risk factor of anxiety, depression,affective disorde and comorbidity of anxiety and depressi-on(OR = 3.135, 95%CI1.310 to 7.506)(OR = 3.027, 95%CI1.317 to 6.959)(OR =2.789, 95%CI1.267 to 6.140),(OR =4.735, 95%CI1.811 to 12.382).On the contrary, drinking was the protective factor of depression twelve months after PCI(OR =0.254, 95%CI0.073 to 0.890).5 The change trend of anxiety and/or depression prevalence in different periods of percutaneous coronary interventionThere were a significant difference of the anxiety prevalence among the different time periods of PCI(χ2=90.181;P<0.01).what’s more, there existed a linear trend between different time periods and the prevalence of anxiety(P<0.01).One day before PCI, the anxiety prevalence accouted for 34.70%(59 of 170).Moreover, the anxiety prevalence one day after PCI was significantly higher than the prevalence one day before PCI(χ2=13.754;P<0.001).There was no significant difference of the anxiety prevalence between one day after PCI and one month after PCI(χ2=1.178;P=0.278). However, the prevalence of anxiety three months after PCI had started descending more obviously than one month after PCI(χ2=31.288; P<0.001). The different prevalence of six months and twelve months were no founded compared with three months(χ2=2.170, P=0.141; χ2=0.487, P=0.485).We found a significant difference of the depression prevalence among the different time periods of PCI(χ2=54.452;P<0.01). Moreover, there was a linear trend between different time periods and the prevalence of depression(P<0.01). The anxiety prevalence was 23.50%(40 of 170).one day before PCI. At the same time, the depression prevalence one day after PCI was significantly higher than the prevalence one day before PCI(χ2=16.958;P<0.001).Contrasted with the depression prevalence one day after PCI, the prevalence one months and three months after PCI were founded no difference(χ2=0.579, P=0.447; χ2=0.000, P=1.000). However, the prevalence of depression six months after PCI had began to descend more evidently than three months after PCI(χ2=9.952; P<0.003). There was no significant difference of the depression prevalence between six months and twelve months after PCI(χ2=1.898, P=0.168).There were a significant difference of the affective disorder prevalence among the different time periods of percutaneous coronary intervention operation(χ2=101.589;P<0.01).what’s more, there existed a linear trend between different time periods and the prevalence affective disorder(P<0.01). The affective disorder prevalence accouted for 43.50%(74 of 170) one day before PCI. At the same time, the affective disorder prevalence one day after PCI was significantly higher than the prevalence one day before PCI(χ2=27.755;P<0.001).Compared with the affective disorder prevalence one day after PCI, the prevalence one months and three months after PCI were founded no difference(χ2=0.057, P=0.811; χ2=6.839, P=0.009). However, the prevalence of affective disorder six months after PCI had came on to drop more remarkably than one months after PCI(χ2=14.239; P<0.001). what’s more,the affective disorder prevalence of twelve months after PCI was lower than months(χ2=20.875, P<0.001).We found a significant difference of the comorbidity of anxiety and depression prevalence(χ2=64.828;P<0.01)among the different time periods of percutaneous coronary intervention operation.In addition, there was a linear trend between different time periods and the comorbidity of anxiety and depression prevalence(P<0.01). The comorbidity of anxiety and depression prevalence one day after PCI was significantly higher than the prevalence one day before PCI(χ2=8.528;P<0.0033).There was no significant difference of the comorbidity of anxiety and depression prevalence between one day after PCI and one month after PCI(χ2=0.015;P=0.903). However, the comorbidity of anxiety and depression prevalence three months after PCI had started to decline more notably than one month after PCI(χ2=25.820;P<0.001). The prevalence of six months and twelve months were no founded different in contrast to three months(χ2=0.502, P=0.479; χ2=3.450, P=0.063). 6 No major cardiovascular events was found following up of 12 months.Conclusion:The higher prevalence of anxiety and comorbidity of anxiety and depression exited after percutaneous coronary intervention operation until a month or so, and then the prevalence of anxiety significantly decreased along with the time going, and maintained at a certain level. The same were depression and affective disorder prevalence except rising for three months. |
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