Persistent angina: highly prevalent and associated with long-term anxiety, depression, low physical functioning, and quality of life in stable angina pectoris
Persistent angina: highly prevalent and associated with long-term anxiety, depression, low physical functioning, and quality of life in stable angina pectoris
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DOI：
10.1007/s00392-013-0568-z
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发表时间：
2013-08-01
影响因子：
5
通讯作者：
Prescott, Eva
中科院分区：
文献类型：
--
作者：
Jespersen, Lasse;Abildstrom, Steen Z.;Prescott, Eva
为了评估无阻塞性冠状动脉疾病 (CAD) 的稳定型心绞痛与阻塞性 CAD 的持续性心绞痛及其与长期焦虑、抑郁、生活质量 (QOL) 和身体机能的关系。我们邀请了 357 名既往无心血管疾病的患者（男性 = 191；女性 = 166；缓解率 83%），他们在 2008-2009 年因以下原因进行了首次冠状动脉造影 (CAG)： 2011年，疑似稳定型心绞痛患者参加了以西雅图心绞痛问卷和医院焦虑抑郁量表为关键要素的问卷调查。 64% 的弥漫性非阻塞性 CAD 患者（1-49% 狭窄）、49% 的正常冠状动脉患者（0% 狭窄）和 41% 的阻塞性 CAD 患者（千分之一 50% 狭窄）存在长期持续性心绞痛（即每月至少一次症状）（P = 0.01）。抑郁和焦虑在持续性心绞痛患者中更为常见：24% 与 7% (P < 0.001) 报告的 HADS 抑郁评分 > 7，42% 与 21% (P < 0.001) 报告的 HADS-焦虑评分 > 7。在多变量回归模型中，持续性心绞痛与抑郁相关（OR 4.3，95% 置信区间 (CI)） 1.9-9.6，P < 0.001），焦虑（或 2.9，95 % CI 1.6-5.1，P < 0.001）、持续性心绞痛伴身体功能受损的严重程度（P < 0.001）和生活质量（P < 0.001）；而结果与年龄、性别或 CAD 程度无关。该研究表明，弥漫性非梗阻性 CAD 或正常冠状动脉患者的持续性心绞痛患病率高于梗阻性 CAD 患者。无论 CAD 的程度如何，持续的心绞痛症状都与长期焦虑、抑郁、身体功能受损和生活质量相关。与普遍看法相反，排除稳定性心绞痛中的阻塞性 CAD 并不能确保良好的病程，需要进一步的风险分层和治疗策略。
To evaluate persistent angina in stable angina pectoris with no obstructive coronary artery disease (CAD) compared to obstructive CAD and its relation to long-term anxiety, depression, quality of life (QOL), and physical functioning.We invited 357 patients (men = 191; women = 166; response rate 83 %) with no prior cardiovascular disease who had a first-time coronary angiography (CAG) in 2008-2009 due to suspected stable angina to participate in a questionnaire survey in 2011 with the Seattle Angina Questionnaire and the Hospital Anxiety and Depression Scale as key elements. Long-term persistent angina (i.e., symptoms at least once a month) was present in 64 % of patients with diffuse non-obstructive CAD (1-49 % stenosis), 49 % of patients with normal coronary arteries (0 % stenosis), and 41 % of patients with obstructive CAD (a parts per thousand yen50 % stenosis) (P = 0.01). Depression and anxiety were more common in patients with persistent angina: 24 versus 7 % (P < 0.001) reported HADS-Depression-scores > 7 and 42 versus 21 % (P < 0.001) reported HADS-Anxiety-scores > 7. In multivariate regression models, persistent angina was associated with depression (OR 4.3, 95 % confidence interval (CI) 1.9-9.6, P < 0.001), anxiety (OR 2.9, 95 % CI 1.6-5.1, P < 0.001), the severity of persistent angina with impaired physical functioning (P < 0.001), and QOL (P < 0.001); whereas outcomes were not related to age, gender, or degree of CAD.The study indicates higher prevalence of persistent angina in patients with diffuse non-obstructive CAD or normal coronary arteries than in patients with obstructive CAD. Persistent angina symptoms were associated with long-term anxiety, depression, impaired physical functioning, and QOL irrespective of the degree of CAD. Contrary to common perception, excluding obstructive CAD in stable angina does not ensure a favorable disease course, and further risk stratification and treatment strategies are warranted.