Predictors Of Depression/Anxiety In Patients With CHD/ACS And Their Effects On Prognosis

Purpose:To observe the occurrence of depression/anxiety in patients with coronary heart disease(CHD)/Acute coronary syndrome(ACS)and their correlation with the prognosis of patients,and to explore the correlation between depression/anxiety and inflammatory biomarkers.Methods: 1.173 patients with CHD who underwent coronary angiography were enrolled.Clinical data recorded,and the Gensini score was calculated.All patients completed Patient Health Questionnaire(PHQ-9)and Generalized Anxiety Disorder-7(GAD-7)to assess depression and anxiety symptom before discharge.Follow-up 3 months and record the occurrence of Major Adverse Cardiovascular Events(MACE)with patients.Characteristics of patients with depression/anxiety symptoms,and their relationship with Gensini scores and the incidence of MACE were analyzed.2.225 patients with ACS were enrolled.Their clinical data,PHQ-9 score and GAD-7 score were recoded.GRACE scores were calculated and patients were divided into low-risk group,medium-risk group and high-risk group according to the scores.The clinical data and depression /anxiety of patients between the three groups were compared.The risk factors of high-risk ACS patients were analyzed,and the correlation between depression/anxiety and inflammatory indicators in ACS patients was discussed.Results:1.(1)More than one-third of patients with CHD have symptoms of depression/anxiety.Baseline data showed that the incidence of patients with depressive symptoms was higher in women,relatively older,old myocardial infarction,diabetes,and higher Gensini scores(P<0.05).The incidence of anxiety in patients with relatively older,smoking,in-hospital > 7 days,higher urea nitrogen,an-d higher Gensini scores(P < 0.05).(2)The PHQ-9 score and GAD-7 score were not completely equal among different groups based on Gensini score quartile-s,and the highest was in the >75% group(P <0.05).Spearman rank correlation analysis revealed that PHQ-9 score and GAD-7 score(r=0.258,r=0.317,P<0.05)were positively correlated with Gensini score.(3)After 3 months of follow-up,MACE occurred in 28 patients including 19 with depressive symptoms and 15 with anxiety symptoms.The incidence of MACE in patients with positive depression/anxiety symptoms was significantly higher than that with negative symptoms(P<0.05).2.(1)Compared with the high-risk group,the PHQ-9 score,GAD-7 score,positive depression rate and anxiety rate were significantly lower in the low-risk group and the middle-risk group(P<0.05).There were no significant differences between patients in the low-risk group and intermediate-risk group.(2)Gradual logistic regression analysis was performed with high-risk group as the dependent variable.The results showed that age(OR1.118,95% CI: 1.072-1.166),creatinine(OR1.027,95% CI: 1.007-1.048),C-reactive protein(CRP)(OR1.169,95% CI: 1.023-1.335),depressive symptoms(OR2.84,95% CI: 1.367-5.905)and anxiety symptoms(OR3.508,95% CI: 1.659-7.418)were independent risk factors of high risk ACS.(3)The GRACE score,CRP,Neutrophil-lymphocyte ratio(NLR)and Platelet-lymphocyte ratio(PLR)levels in patients with positive depression/anxiety were significantly higher than those with negative symptoms.(P<0.05).(4)The ROC curve analysis results showed that the area under the ROC curve of depression-related/anxiety-related NLR was 0.610 and 0.623,the area under the PLR curve was 0.587 and 0.652,and the area under the CRP curve was 0.602 and 0.627,respectively.Conclusion: 1.CHD/ACS patients with depression/anxiety disorder often have special clinical characteristics.2.The severity of depression and anxiety symptoms was positively correlated with the degree of coronary artery disease in patients with CHD,and significantly increased the incidence of MACE events.3.The symptoms of depression and anxiety are related to the severity of ACS patients,and they are the predictors of the high risk of ACS.4.Inflammatory indicators CRP,NLR and PLR are significantly correlated with depression/anxiety in ACS patients,which can provide reference for cardiology clinicians to detect and intervene ACS patients with depression/anxiety timely.