Depression/Anxiety And The Prognosis Of Patients With Coronary Artery Disease Before And After PCI Treatment

Background:Coronary heart disease is one of the major diseases with high morbidity and mortality in the world,and it is also one of the serious diseases that may cause major psychological and economic burdens in today’s society.Studies have found that patients with coronary heart disease often coexist with a series of psychological emotions,especially negative emotions such as anxiety,depression,anger,etc.Long-term accompanied by such negative emotions will affect the prognosis of the disease.At present,the most commonly used and effective treatment method for coronary heart disease is percutaneous coronary intervention(PCI),which can reduce the pain caused by the disease,improve health and improve the quality of life.However,due to the high cost of surgery,surgery Existing risks,long-term medication after surgery and other factors,patients have psychological emotions such as anxiety and depression before and after PCI.Therefore,more and more scholars at home and abroad have begun to pay attention to and study the mental health status of patients with coronary heart disease,emphasizing that medical staff should pay attention to the psychological status of patients during the course of the disease while recovering the heart function of coronary heart disease.Purpose:This study aims to explore the depression and anxiety of patients with coronary heart disease during PCI perioperative period,and the prevalence of depression,anxiety and major adverse cardiovascular events(MACE)at different time points during the 6-month follow-up,analyze the related factors of depression and anxiety,and the influence of depression and anxiety on the prognosis of the disease.Methods:A total of 160 patients with coronary heart disease who received PCI treatment in the department of cardiology of Subei People’s Hospital from November 2019 to November 2020 and who met the inclusion criteria and did not meet the exclusion criteria were selected.Record the general information of the patient,including name,age,gender,marital status,occupation,education level,annual income level,height,weight,body mass index(BMI),and type of hospitalization expenses.History of heart disease,history of hypertension,history of diabetes,history of cerebral infarction,personal history including history of smoking,history of drinking,clinical data including the number and type of stent implanted during PCI and the occurrence of MACE within 6 months of follow-up after discharge.Patient Health Questionnaire-9(PHQ-9)and Generalized Anxiety Disorder-7(GAD-7)were used 1 day before PCI,1day after surgery,1 month,3 months,and 6 months after surgery,to screen for depression and anxiety.According to the scores,they were divided into depression group,anxiety group,depression and anxiety(comorbidity group),and recorded within6 months after surgery what happened to MACE.Use Excel software to establish a database,and use SPSS23.0 software for statistical analysis.If the measurement data conform to the normal distribution,the description of mean and standard deviation are adopted;if the measurement data conform to the skewed distribution,the description of median and quaternary is adopted.Enumeration data were described and analyzed in the form of frequency and percentage.Chi-square test was used for comparison between groups.Binary logistics regression analysis was used to analyze the factors affecting depression and anxiety,and Cox proportional risk regression model was used to analyze the related influencing factors of MACE.Results:1.The prevalence of depression in different periods of 1 day before PCI,1 day after surgery,1 month after surgery,3 months after surgery and 6 months after surgery were18.1%,21.9%,20%,15.6%,and 9.4%,the prevalence of anxiety were 28.8%,32.5%,34.4%,30%,and 21.3%,the prevalence of depression and anxiety(comorbidities)were6.9%,13.1%,11.9%,9.4%,and 5.6%.The chi-square trend test was performed with the rstatix package of R language,and it was found that the prevalence of depression group(χ~2=6.396,P=0.011)had a statistically significant trend over time(P<0.05),while the anxiety group(χ~2=2.362,P=0.124)and the comorbidity group(χ~2=0.736,P=0.391)showed no statistical significance over time.2.The depression and anxiety at different time points were analyzed by chi-square test:the depression group was compared with the non-depression group in terms of gender(female),age(<60 years old),annual income level(<100,000),and education(junior and high school),BMI(24-27),a history of hypertension,a history of diabetes,a history of coronary heart disease,a history of smoking,and the number of stents implanted during PCI were statistically different(P<0.05).Compared with the non-anxiety group,the anxiety group is in terms of gender(female),education(junior high school and high school),previous history of hypertension,history of coronary heart disease,history of smoking,and the number of stents implanted during PCI were statistically different(P<0.05).3.The variables with statistical significance in the chi-square test(P<0.05)were included in the binary logistic regression analysis equation,and finally 5 variables were included in the regression equation related to depression,namely gender(female)and age(<60 years old),BMI(24-27),previous history of coronary heart disease,and history of smoking.Using the same method,five variables were included in the regression equation related to anxiety,namely gender(female),education(junior high school and high school),previous history of coronary heart disease,history of hypertension,and history of smoking.The variables included in the equation were all statistically significant(P<0.05).4.160 patients who underwent PCI were followed up for 6 months.There were 44cases of MACE(27.5%),including 24 males(22.6%)and 20 females(37%).In the MACE event,patients mainly showed recurrence of angina pectoris(42 cases),re-PCI treatment(2 cases),and no serious arrhythmia,heart failure,death and other events occurred.The traditional factors that affect the prognosis of coronary heart disease(such as gender,age stratification,whether it is combined with hypertension and diabetes history),together with depression and anxiety factors,were used to establish a Cox proportional risk regression model.The results suggest that there is hypertension(OR=3.791,P=0.007),postoperative depression(OR=2.420,P=0.010),postoperative anxiety(OR=0.279,P=0.028)were related to the occurrence of MACE,and the difference was statistically significant(P<0.05).Conclusions:1.Patients with coronary heart disease may experience depression and anxiety during PCI perioperative period and within 6 months after surgery.The prevalence of depression is 9.4%-21.9%,the prevalence of anxiety is 21.3%-34.4%,the prevalence of depression and anxiety is 5.6%-13.1%.It was found that the prevalence of depression gradually decreased over time after PCI.However,this change was not found in anxiety and comorbidities.2.Gender(female),previous history of coronary heart disease and smoking history are common risk factors for depression and anxiety.However,age(<60 years old)and BMI(24-27)have also been found to be risk factors for depression,education(junior high school and high school)and a previous history of hypertension may be risk factors for anxiety.3.The depression and anxiety of patients with coronary heart disease after PCI will have a negative impact on the prognosis of the disease.The risk of MACE in patients with coronary heart disease with depression and anxiety is 2.42 times and 0.28 times that of patients with coronary heart disease without depression and anxiety.