Fatigue, depressive symptoms, and hopelessness as predictors of adverse clinical events following percutaneous coronary intervention with paclitaxel-eluting stents.
OBJECTIVE
We investigated the relative effects of fatigue, depressive symptoms, and hopelessness on prognosis at 2-year follow-up in percutaneous coronary intervention (PCI) patients.


METHODS
Consecutively admitted PCI patients (n=534) treated with paclitaxel-eluting stent as the default strategy completed the Maastricht Questionnaire (MQ) at baseline. Apart from an overall vital exhaustion score, the MQ also assesses fatigue (seven items; Cronbach's alpha=.87) and depressive symptoms (seven items; Cronbach's alpha=.83), with hopelessness (one item) comprised in the depressive symptom items. Patients were followed up for adverse clinical events (mortality and nonfatal myocardial infarction) at 2 years.


RESULTS
At 2-year follow-up, there were 31 clinical events. In univariable analyses, overall vital exhaustion and depressive symptoms, but not fatigue, were associated with adverse prognosis; in multivariable analysis, depressive symptoms [hazard ratio (HR)=2.69; 95% confidence interval (95% CI)=1.31-5.55] remained the only predictor of clinical outcome. Among the depressive symptoms, hopelessness (HR=3.44; 95% CI=1.65-7.19) was the most cardiotoxic symptom. The incidence of clinical events was higher in the high-hopelessness patients (11% vs. 3%; P=.001) than in the low-hopelessness patients. Hopelessness (HR=3.36; 95% CI=1.58-7.14; P=.002) remained an independent predictor of clinical outcome at 2 years in adjusted analysis.


CONCLUSIONS
Symptoms of depression, but not fatigue, predicted adverse clinical events. Hopelessness was the most cardiotoxic symptom, associated with a more than three-fold risk of clinical events 2 years post-PCI. Screening for hopelessness may lead to the identification of high-risk patients.
Pedersen
Susanne S
SS
CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands. s.s.pedersen@uvt.nl
Denollet
Johan
J
Daemen
Joost
J
van de Sande
Meike
M
de Jaegere
Peter T
PT
Serruys
Patrick W
PW
Erdman
Ruud A M
RA
van Domburg
Ron T
RT
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000523:psychology*; D020099:Coated Materials, Biocompatible; D003327:Coronary Disease / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005221:Fatigue / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009203:Myocardial Infarction / Q000401:mortality / Q000523:psychology; D017239:Paclitaxel / Q000008:administration & dosage*; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate
D020099:Coated Materials, Biocompatible; D017239:Paclitaxel