Mental stress-induced myocardial ischemia and cardiac events
Mental stress-induced myocardial ischemia and cardiac events
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DOI：
10.1001/jama.275.21.1651
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发表时间：
1996-06-05
影响因子：
120.7
通讯作者：
Blumenthal, JA
中科院分区：
文献类型：
--
作者：
Jiang, W;Babyak, M;Blumenthal, JA
目的：-评估冠心病(CAD)患者心理应激引起的心肌缺血的临床意义。设计和设置。-对一家三级护理教学医院的门诊患者进行队列研究，在基线下进行评估，并进行长达5年的随访。受试者-共有126名志愿者患者(112名男性，14名女性；平均年龄59岁)，他们有明确的冠心病和运动性心肌缺血记录。结果：-患者接受了基线心理应激和运动测试，使用放射性核素脑室造影术和48小时Holter监测。随后通过邮寄问卷或电话联系患者，记录包括死亡、非致命性心肌梗死和心脏血运重建手术在内的心脏事件，使用Logistic回归和Cox比例风险模型，在调整了年龄、基线左心室射血分数(LVEF)和心肌梗塞史等潜在混杂因素后，检验缺血措施的预后价值。结果：28例(22%)患者至少经历过一次心脏事件，基线精神应激诱导的缺血与后续心脏事件的发生率显著增加(优势比，2.8；95%可信区间[CI]，1.0-7.7；P
Objective.-To assess the clinical significance of mental stress-induced myocardial ischemia in patients with coronary artery disease (CAD).Design and Setting.-Cohort study in outpatients in a tertiary care teaching hospital assessed at baseline and followed up for up to 5 years.Subjects.-A total of 126 volunteer patients (112 men, 14 women; mean age, 59 years) with documented CAD and exercise-induced myocardial ischemia.Outcome Measures.-Patients underwent baseline mental stress and exercise testing using radionuclide ventriculography and 48-hour Holter monitoring. Patients were subsequently contacted by mailed questionnaires or telephone to document cardiac events, including death, nonfatal myocardial infarction, and cardiac revascularization procedures, Logistic regression and Cox proportional hazards models were used to examine the prognostic value of the ischemic measures after adjusting for such potential confounding factors as age, baseline left ventricular ejection fraction (LVEF), and history of myocardial infarction.Results.-Twenty-eight patients (22%) experienced at least 1 cardiac event, Baseline mental stress-induced ischemia was associated with significantly higher rates of subsequent cardiac events (odds ratio, 2.8; 95% confidence interval [CI], 1.0-7.7; P