稳定型冠心病患者主要不良心血管事件与精神压力诱发心肌缺血的关系OA

Objective To explore the relationship between major adverse cardiovascular events(MACE)in patients with stable coronary artery disease(SCAD)and mental stress-induced myocardial ischemia(MSIMI).Methods A total of 380 patients with SCAD who were admitted to Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from March 2020 to September 2022 were selected.During the 1-year follow-up period,the occurrence of MACE[including cardiogenic death,non-fatal acute myocardial infarction(AMI),and cardiogenic rehospitalization]was recorded in detail.The patients were divided into the MACE group(n=78)and the non-MACE group(n=302)based on occurrence of MACE.The clinical data,Gensini score,left ventricular ejection fraction(LVEF),9-item Patient Health Questionnaire-9(PHQ-9 score)for depression,7-item Generalized Anxiety Disorder Questionnaire(GAD-7)score,and the positive rate of MSIMI were compared between the two groups.Multivariate logistic regression analysis was used to analyze the factors influencing the occurrence of MACE in patients with SCAD.Results Among the 380 SCAD patients,a total of 78 patients developed MACE during the 1-year follow-up period,and the incidence of MACE was 20.53%.There were 6 cases of cardiogenic death,27 cases of non-fatal AMI,and 61 cases of cardiogenic readmission.Among them,1 case of cardiogenic death and 15 cases of non-fatal AMI were simultaneously counted as cardiogenic readmissions.Age,proportion of moderate to severe coronary artery calcification,Gensini score,PHQ-9 score,and GAD-7 score in the MACE group were higher than those in the non-MACE group,while the LVEF was lower than that in the non-MACE group(P<0.05).The positive rate of MSIMI in the MACE group was 44.87%(35/78),which was higher than 19.87%(60/302)in the non-MACE group(P<0.05).Multivariate logistic regression analysis showed that Gensini score,increased GAD-7 score,and positive MSIMI were all independent risk factors for the occurrence of MACE in SCAD patients(P<0.05).Conclusion MSIMI is an important indicator for risk stratification of MACE in patients with SCAD.In clinical practice,actively establishing a psycho-cardiology management model and focusing on developing effective psychological stress reduction strategies can help reduce the risk of MACE in SCAD patients.