BIOBEHAVIORAL PREDICTORS OF CORONARY ANGIOPLASTY OUTCOME

冠状动脉血管成形术结果的生物行为预测因子

• 批准号: 2618377
• 负责人: Willem Johan Kop
• 金额: $ 12万
• 依托单位: HENRY M. JACKSON FDN FOR THE ADV MIL/MED
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-02-01 至 2003-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2618377
• 关键词: angers; behavior prediction; behavioral /social science research tag; cardiovascular stress test; clinical research; clotting factor; depression; disease /disorder proneness /risk; echocardiography; heart revascularization; hemodynamics; human subject; interview; longitudinal human study; outcomes research; prognosis; psychological stressor; psychophysiology; restenosis; stress

Percutaneous coronary revascularization procedures are increasingly used in the treatment of coronary artery disease, with approximately 300,000 interventions performed each year. Despite new developments in cardiology such as infra-coronary stents and anticoagulant pharmacological treatments a major problem remains the frequent occurrence of coronary restenosis and new cardiac events within six months after the intervention. These adverse outcomes occur in one out of four patients and have substantial impact on the costs of medical care and patients' quality of life. Research indicates that hemostatic factors (e.g., fibrinogen, von Willebrand factor, and plasminogen activator inhibitor) promote the formation of blood clots and that these factors predict coronary restenosis. Moreover, prior longitudinal studies have also demonstrated that the psychosocial traits of hostility and depression affect clinical progression of coronary disease. These psychosocial factors significantly predict adverse long-term outcome after revascularization and both hostility and depression are known to affect blood clotting factors. In addition, acute mental and physical stress are reported to affect blood clotting factors (coagulation and fibrinolysis) and responses to stress are reported to be more pronounced in hostile individuals. However, previous research on predictors of adverse clinical outcome after percutaneous coronary revascularization has not examined stress-induced changes in hemostatic factors and the consequences of these responses for progression of coronary artery disease. Therefore, the present study will investigate whether psychosocial factors and responses to acute mental stress affect measures of the blood clotting process that are involved in progression of coronary disease, thereby increasing the risk of an adverse prognosis following percutaneous coronary revascularization. This study may improve the identification of patients at risk for recurrent cardiac events and provide further understanding of the pathophysiological mechanisms involved in the progression of coronary artery disease.

经皮冠状动脉血运重建程序越来越多地用于治疗冠状动脉疾病，每年进行约300,000例干预措施。尽管心脏病学上的新发展，例如冠状动脉支架和抗凝药物治疗，但在干预后的六个月内，冠状动脉再狭窄和新心脏事件的主要问题仍然存在。这些不良结果发生在四分之一患者中，并对医疗和患者生活质量的成本产生重大影响。 研究表明，止血因子（例如纤维蛋白原，von Willebrand因子和纤溶酶原激活剂抑制剂）促进了血凝块的形成，并且这些因素可以预测冠状动脉再狭窄。 此外，先前的纵向研究还表明，敌对和抑郁的心理特征会影响冠状动脉疾病的临床进展。 这些社会心理因素可以显着预测血运重建后的不良长期结果，并且敌对和抑郁症都会影响血液凝血因素。 此外，据报道，急性精神和身体压力会影响血液凝结因子（凝结和纤维蛋白溶解），并且据报道对压力的反应在敌对的个体中更为明显。 但是，先前对经皮冠状动脉血运重建后不良临床结果预测指标的研究未检查压力诱导的止血因素的变化以及这些反应对冠状动脉疾病进展的后果。 因此，本研究将研究心理疾病进展的血液凝结过程的心理因素和对急性精神压力的反应是否会影响经皮冠状动脉血运重建后不良预后的风险。 这项研究可能会改善对复发性心脏事件风险的患者的鉴定，并进一步了解涉及冠状动脉疾病进展的病理生理机制。