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: 6351507
• 负责人: Willem Johan Kop
• 金额: $ 10.21万
• 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/6351507
• 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术越来越多地用于治疗冠状动脉疾病，每年进行约300，000次介入治疗。尽管心脏病学有了新的发展，如冠状动脉下支架和抗凝药物治疗，但一个主要问题仍然是在干预后六个月内频繁发生冠状动脉再狭窄和新的心脏事件。这些不良后果发生在四分之一的患者中，并对医疗费用和患者的生活质量产生重大影响。 研究表明，止血因素（例如，纤维蛋白原、血管性血友病因子和纤溶酶原激活物抑制剂）促进血凝块的形成，并且这些因素预测冠状动脉再狭窄。 此外，先前的纵向研究也表明，敌对和抑郁的心理社会特征影响冠状动脉疾病的临床进展。 这些心理社会因素显著预测血管重建术后不良的长期结果，并且已知敌意和抑郁都会影响凝血因子。 此外，据报道，急性精神和身体压力会影响凝血因子（凝血和纤维蛋白溶解），据报道，对压力的反应在敌对个体中更为明显。 然而，先前关于经皮冠状动脉血运重建术后不良临床结局的预测因子的研究尚未研究应激诱导的止血因子变化以及这些反应对冠状动脉疾病进展的后果。 因此，本研究将探讨心理社会因素和对急性精神应激的反应是否会影响与冠心病进展有关的凝血过程的测量，从而增加经皮冠状动脉血运重建术后不良预后的风险。 这项研究可能会提高识别患者的心脏事件复发的风险，并提供进一步了解的病理生理机制参与冠状动脉疾病的进展。