Neglected cardiovascular risk factors: Relationship of anxiety and depression with percutaneous coronary angioplasty

Introduction: Coronary artery disease (CAD) is the leading cause of mortality in Malaysia. Psychological risk factors are associated with detrimental outcomes in CAD. Our study aimed to evaluate procedural anxiety and depression levels among subjects who underwent coronary angioplasty. Methods: A single-centre prospective cohort study was conducted on patients electively admitted to a tertiary hospital in Malaysia for percutaneous coronary intervention (PCI) over a half-year period. The Hospital Anxiety and Depression Scale (HADS) and the EuroQol-5 Dimension (EQ5D) Health Questionnaire were used to evaluate subjects' psychological statuses. The EQ Visual Analogue Scale was used for the global assessment of their health. Results: The analysis included 65 patients with a mean age of 63 years from a predominately educated population (n=54; 83.1%). Before the PCI procedure, female sex was found to be protective against depression, with an odds ratio (ORs) of 0.29 (95% confidence interval (CI) 0.08-1.03). A high level of education was protective against anxiety (OR=0.21; 95% CI 0.06-0.83). After the PCI, females were more likely to be depressed (OR=3.89; 95% CI 1.13-13.37), and those of Malay ethnicity were more likely to be anxious (OR=4.2; 95% CI 1.03-17.07). Using the HADS, subjects were significantly less anxious and depressed (pre-PCI: median (IQR) score=4 (7.0)); post-PCI: median (IQR) score=3 (5.0), p=0.02), measured by the HADS. Using the EQ5D, subjects had an improved mean VAS score (post-PCI: 75 +/- 14.9; pre-PCI: 68 +/- 12.6; p<0.05). Conclusions: PCI may predispose patients with CAD to psychological stressors. Female patients and those of Malay ethnicity are more likely to experience psychological stress. Being highly educated is protective against such stress.