Supervisors info:
Σπ . Μεντεζελόπουλος, Αν Καθηγητής,Ιατρική, ΕΚΠΑ
Θ . Ξανθος, Καθηγητης ,Ιατρική, ΕΚΠΑ
Γ. Γκιόκας, Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
OBJECTIVE: The purpose of this thesis was to investigate the relationship of anxiety and depression with the severity of coronary heart disease, based on biochemical or imaging findings, in patients with acute coronary syndrome who were hospitalized in the CCU unit.
METHODS: This is a cross-sectional study, the population of which consists of 200 consecutive patients (82% men), with a presentation of an acute coronary syndrome , who were hospitalized in the cardiac care unit for further treatment (conservative or invasive). Throughout the study population, complete biochemical, electrocardiographic, ultrasound, and oral interview and supplementation of the Hamilton Depression and Anxiety Scale were performed.
RESULTS: The average age of study patients was 61 ± 13 years, with men accounting for 82% of the population. The mean value of the HAM-D and HAM-A questionnaires studied was 11 ± 5.6 and 9.3 ± 4.5 degrees, respectively. In the total population, 34% had a HAM-D score very low <8, 48% between 8-16 total score, 15% had a high score between 17-23 and only 3% had a very high score> 23 With regard to the HAM-A questionnaire, 93% had a low overall score of <17 and only 7% had a high score> 17.
Based on the overall HAM-D score, statistically significant differences were found with respect to the lipid profile, with patients with very high scores> 23 exhibiting elevated total and LDL cholesterol levels with an average of 277 ± 94 and 199 ± 73, respectively (p value <0.009 and p value <0.006, compared to low-score patients), and did not differ in triglyceride and HDL cholesterol levels. Also, differences were observed with regard to the type of acute coronary syndrome, with patients with low HAM-D scores exhibiting more oftenly acute coronary syndrome with ST elevation whereas patients with high and very high scores most often exhibited acute coronary syndrome without ST eleveation or unstable angina (p value = 0.044 for all).
The test for possible correlations of the overall score of the HAM-D questionnaire revealed a statistically significant positive correlation of the type of the acute coronary episode and the total score (r = 0.214, p value = 0.032). A statistically significant positive correlation was also found with the percentage of people who reported financial problems (r = 0.232, p value = 0.020). Finally, multifactorial regression analysis highlighted economic problems as an independent factor in the HAM-D and HAM-A questionnaires, weighing on potential confounding factors such as age, sex and type of acute coronary syndrome.
CONCLUSIONS: Both acute coronary syndromes and depression are diseases with high prevalence in the general population, and are associated with deterioration in quality of life. Depression is often present in patients with coronary artery disease and acute coronary syndromes and is associated with increased cardiovascular mortality and morbidity. In the present study we managed to highlight the relationship between the type of acute coronary syndromes and depression and that economic problems are an independent factor of depression and anxiety with a greater effect on the female sex.
Keywords:
Psychological effects, Acute myocardial infarction, Depression, Anxiety, Coronary care unit
