title: Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting.
abstract: OBJECTIVE
  Previous studies in post-myocardial infarction patients with heart failure have documented that high anxiety levels are associated with increased mortality. In this prospective study, we determined the impact of anxiety on long-term event risk in stable coronary heart disease (CHD) patients treated with percutaneous coronary interventions (PCIs).
  
  
  METHODS
  A total of 470 patients referred for PCI completed the Hospital Anxiety and Depression Scale (HADS) before undergoing stent implantation. Over a five-year follow-up period, data on survival, occurrence of major adverse cardiovascular events (MACEs) and repeat revascularization were obtained from n = 462 participants (98.3%).
  
  
  RESULTS
  All-cause mortality rates differed significantly across the four quartiles of the HADS anxiety subscale, the lowest number of deaths (1.9%) being seen in patients with the highest HADS-A quartile (scores ≥ 10) as compared to those in the three lower quartiles (11.8%, odds ratio = 0.14, 95%-confidence interval (95% CI): 0.03-0.60, p = 0.002). Cox regression models adjusted for a variety of potential somatic and procedural confounders confirmed the results from the univariate analyses (hazard ratio (HR) = 0.21, 95% CI: 0.05-0.91, p = 0.037). There were also fewer MACEs in anxious patients as compared to non-anxious subjects (HR = 0.34, 95% CI: 0.14-0.80, p = 0.014). In contrast, anxious patients had a higher rate of repeat revascularization (26.4% versus 16.6%, p = 0.033).
  
  
  CONCLUSIONS
  In CHD patients undergoing elective PCI, higher anxiety levels are positively associated with survival and reduce the risk for MACE during the first five years after index PCI. The beneficial effects of anxiety on cardiovascular mortality and morbidity suggest that a differentiated approach to diagnosing and treating anxiety in CHD patients is warranted.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meyer
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Germany.
authors.forename: Sharif
authors.initials: S
authors.lastname: Hussein
authors.affiliation: Cardiological Practice, Heart Center Bremen, Germany.
authors.forename: Helmut W
authors.initials: HW
authors.lastname: Lange
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Germany cherrma@gwdg.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Herrmann-Lingen
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D002423:Cause of Death; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D019233:Retreatment; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary heart disease; anxiety; mortality; prognosis