The Predictive Effect of Negative Psychological Emotions of Anxiety and Depression on the Poor Prognosis of CHD Patients with Stent Implantation and the Improvement of Clinical Intervention Measures

Abstract

Objective. To explore the predictive effect of negative emotions such as anxiety and depression on the poor prognosis of coronary heart disease (CHD) patients with stent implantation and to seek the improvement of clinical intervention measures. Methods. A total of 303 patients with CHD and PCI were recruited from February 2019 to April 2021. The risk factors of CHD such as anxiety and depression, age, sex, smoking and drinking, BMI, hypertension, diabetes, dyslipidemia, and family history of CHD were collected. Meanwhile, clinical data such as laboratory examination, angiography, diseased vessels, and stent types were collected. The patients were followed up for 1 year, and the medical records, hospitalization records, or death records were checked by telephone interview once a month. Major adverse cardiovascular events (MACE) such as emergency and causes, readmission times and causes, new nonfatal myocardial infarction, stent restenosis, heart failure, arrhythmia, and death were recorded. The incidence of anxiety and depression in patients after PCI was counted, and Cox regression was applied to analyze the influence and prediction of anxiety and depression on MACE in patients with CHD stent implantation and improve clinical intervention measures. Results. Compared with those without MACE, anxiety (56.25% vs 30.63%), depression (62.5% vs 22.88%, $P<0.01$ ), anxiety combined with depression (46.88% vs 15.50%, $P<0.01$ ), and hypertension history (71.8% vs 39.11%, $P<0.01$ ) were more common in patients with MACE. Uncorrected Cox proportional hazard regression found that people with anxiety had a higher risk of developing MACE than those without anxiety (HR 3.181, $P<0.01$ ). Multiple Cox proportional hazard regression analysis of anxiety showed that anxiety was an independent predictor of cumulative MACE ( $P<0.01$ ). The risk of developing MACE in patients with anxiety was 3.742 times higher than that in patients without anxiety ( $P<0.01$ ). Uncorrected Cox hazard regression analysis showed that people with depression had a higher risk of developing MACE than those without depression (HR 5.434, $P<0.01$ ). Furthermore, the results also uncovered that depression was an independent predictor of cumulative MACE ( $P<0.01$ ). The risk of MACE in patients with depression was 3.087 times higher than that in patients without depression ( $P<0.01$ ). Cox hazard regression showed that the risk of MACE in patients with anxiety and depression was significantly higher than that in patients without anxiety and depression (HR 4.642, $P<0.01$ ). After screening, it was found that anxiety with depression could predict the occurrence of MACE ( $P<0.01$ ). The risk of MACE in patients with anxiety and depression was 3.702 times higher than that in patients without anxiety and depression ( $P<0.01$ ). Cox regression analysis showed that the risk of MACE with only anxiety and depression was 2.793 times higher than that without anxiety and depression (95% CI 0.914 8.526), with no statistical significance ( $P>0.05$ ), and the risk of MACE with depression without anxiety was significantly higher than that without anxiety and depression ( $P<0.01$ ). The risk of MACE in patients with anxiety and depression was 7.303 times higher than that in patients without anxiety and depression ( $P<0.01$ ). Conclusion. Negative emotions such as anxiety and depression can increase the risk of poor prognosis of patients with CHD. Therefore, in clinical work, in addition to routine treatment and nursing during hospitalization, it is recommended to screen patients with depression in CHD patients. Medical staff should use simple and effective assessment tools in time and take active measures to improve the depression of patients. This trial is registered with ChiCTR2200055645.