Self-reported anxiety and the risk of clinical events and atherosclerotic progression among patients with Coronary Artery Bypass Grafts (CABG)
Self-reported anxiety and the risk of clinical events and atherosclerotic progression among patients with Coronary Artery Bypass Grafts (CABG)
复制标题
DOI：
10.1016/j.ahj.2009.08.019
复制
发表时间：
2009-11-01
影响因子：
4.8
通讯作者：
Mittleman, Murray A.
中科院分区：
文献类型：
--
作者：
Rosenbloom, Joshua I.;Wellenius, Gregory A.;Mittleman, Murray A.
背景焦虑症状与冠心病风险增加相关，并且在现有冠心病患者中可能预后不良，但焦虑症状是否影响此类患者的动脉粥样硬化进展尚不确定。因此，我们评估的假设，焦虑症状与不良的临床结果和动脉粥样硬化的进展与以前的冠状动脉旁路移植术（CABG）手术和隐静脉移植术后参加CABG Trial.Methods CABG后试验随机患者的CABG手术史，积极或中度降脂和华法林或安慰剂。在入组时和中位随访4.3年后，对患者进行临床终点随访和冠状动脉造影。结果在调整年龄、性别、种族、治疗分配和冠状动脉旁路移植术后数年的模型中，STAI评分>= 40与死亡或心肌梗死（MI）风险呈正相关。（OR 1.55，95% CI 1.01-2.36，P = .044）。当模型中包括抑郁症状时，这种关联略有减弱，但失去了统计学意义（P =. 11）。STAI评分与死亡或MI风险之间存在剂量反应关系。自我报告的焦虑和动脉粥样硬化进展的graft.Conclusions焦虑症状与隐静脉移植患者死亡或心肌梗死的风险增加，但这种风险并没有出现介导的更广泛的动脉粥样硬化进展。(Am心脏J 2009; 158：867-73。）
Background Symptoms of anxiety are associated with increased risk of coronary artery disease and potentially poor prognosis among patients with existing coronary artery disease, but whether symptoms of anxiety influence atherosclerotic progression among such patients is uncertain. Accordingly, we evaluated the hypotheses that symptoms of anxiety are associated with adverse clinical outcomes and progression of atherosclerosis among individuals with previous coronary artery bypass graft (CABG) surgery and saphenous vein grafts enrolled in the Post-CABG Trial.Methods The Post-CABG Trial randomized patients with a history of CABG surgery to either aggressive or moderate lipid lowering and to either warfarin or placebo. Patients were followed up for clinical end points and coronary angiography was conducted at enrollment and after a median follow-up of 4.3 years. Anxiety symptoms were assessed at enrollment using the state portion of the Spielberger State-Trait Anxiety Inventory (STAI) in 13 17 patients.Results In models adjusting for age, sex, race, treatment assignment and years since CABG surgery, a STAI score >= 40 was positively associated with risk of death or myocardial infarction (MI) (OR 1.55, 95% CI 1.01-2.36, P = .044). This association was attenuated slightly when depressive symptoms were included in the model, but lost statistical significance (P =. 11). There was a dose-response relationship between STAI score and risk of death or MI. There was no association between self-reported anxiety and atherosclerotic progression of grafts.Conclusions Anxiety symptoms are associated with increased risk of death or MI among patients with saphenous vein grafts, but this risk does not appear to be mediated by more extensive atherosclerotic progression. (Am Heart J 2009; 158:867-73.)