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Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis.

ABSTRACT: OBJECTIVES:Anxiety has been suggested to be associated with poor outcomes in patients with acute coronary syndrome (ACS). However, results of previous follow-up studies were inconsistent. The aim of this meta-analysis was to evaluate the association between anxiety and clinical outcomes in patients with ACS, and to investigate the potential role of depression underlying the above association. DESIGN:A meta-analysis of prospective follow-up studies. SETTING:Hospitals. PARTICIPANTS:Patients with ACS. INTERVENTIONS:We included related prospective follow-up studies up through 20 July 2019 that were identified by searching PubMed and Embase databases. A random-effect model was used for the meta-analysis. Anxiety was evaluated by validated instruments at baseline. PRIMARY AND SECONDARY OUTCOME MEASURES:We determined the association between anxiety and risks of mortality and adverse cardiovascular events (MACEs) in patients with ACS. RESULTS:Our analysis included 17 studies involving 39?038 patients wqith ACS. Anxiety was independently associated with increased mortality risk (adjusted risk ratio (RR) 1.21, 95%?CI 1.07 to 1.37, p=0.002) and MACEs (adjusted RR 1.47, 95%?CI 1.24 to 1.74, p<0.001) in patients with ACS. Subgroup analyses showed that depression may at least partly confound the association between anxiety and poor outcomes in patients with ACS. Adjustment of depression significantly attenuated the association between anxiety and MACEs (adjusted RR 1.25, 95%?CI 1.04 to 1.52, p=0.02). Moreover, anxiety was not significantly associated with mortality risk after adjusting for depression (adjusted RR 0.88, 95%?CI 0.66 to 1.17, p=0.37). CONCLUSIONS:Anxiety is associated with increased risk of mortality and MACEs in patients with ACS. However, at least part of the association may be confounded by concurrent depressive symptoms in these patients.

SUBMITTER: Li J

PROVIDER: S-EPMC7351295 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis.

Li Jie J Ji Feng F Song Junxian J Gao Xiangyang X Jiang Deguo D Chen Guangdong G Chen Suling S Lin Xiaodong X Zhuo Chuanjun C

BMJ open 20200709 7

<h4>Objectives</h4>Anxiety has been suggested to be associated with poor outcomes in patients with acute coronary syndrome (ACS). However, results of previous follow-up studies were inconsistent. The aim of this meta-analysis was to evaluate the association between anxiety and clinical outcomes in patients with ACS, and to investigate the potential role of depression underlying the above association.<h4>Design</h4>A meta-analysis of prospective follow-up studies.<h4>Setting</h4>Hospitals.<h4>Par ...[more]

PMID: 32647021

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Project description:ObjectiveThe effect of postdilation in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of postdilation after percutaneous coronary intervention in patients with acute coronary syndrome.MethodsPubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wangfang databases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with postdilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes comprised all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, and the angiographic outcomes were no reflow and slow reflow.Results11 studies met inclusion criteria. In clinical outcomes, our pooled analysis demonstrated that the postdilation had a tendency of decreasing MACE (OR = 0.67, 95% CI 0.45-1.00; P = 0.05) but significantly increased all-cause death (OR = 1.49, 95% CI 1.05-2.12; P = 0.03). No significant difference existed in stent thrombosis (OR = 0.71, 95% CI 0.40-1.26; P = 0.24), myocardial infarction (OR = 1.40, 95% CI 0.51-3.83; P = 0.51), and target vessel revascularization (OR = 0.61, 95% CI 0.21-1.80; P = 0.37) between postdilation and non-postdilation groups. In angiographic outcomes, there were no significant differences in no reflow (OR = 1.19, 95% CI 0.54-2.65; P = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93-1.35; P = 0.24) between two groups.ConclusionsThe postdilation tends to reduce the risk of MACE but significantly increases all-cause death, without significantly affecting stent thrombosis, myocardial infarction, target vessel revascularization, and coronary TIMI flow grade. However, more randomized controlled trials are required for investigating the effect of postdilation for patients with acute coronary syndrome (registered by PROSPERO, CRD42020160748).

Dataset Information

Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis.

Publications

Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis.

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