Published online Nov 19, 2026. doi: 10.5498/wjp.122665
Revised: July 28, 2026
Accepted: September 21, 2026
Published online: November 19, 2026
Processing time: 159 Days and 22.4 Hours
Coronary dissection after balloon dilation is one of the key complications iden
To characterize post-IVUS DCB-associated dissection presence and depression incidence, investigate their relationship with major adverse cardiovascular events (MACE), and define a multidisciplinary predictive model for early psychological risk factor stratification.
A retrospective, single-center cohort study which consecutively enrolled 168 patients with angiographically confirmed coronary dissection after IVUS-guided DCB angioplasty was performed at the Department of Cardiology from April 2020 to September 2024. Psychological status was assessed using the Hospital Anxiety and Depression Scale (HADS, pre-procedure, 1 month and 6 months post-procedure), the Generalized Anxiety Disorder-7 questionnaire and the Patient Health Questionnaire-9. Patients (n = 168) were assigned to an anxiety-depression cohort (high score defined as HADS-A ≥ 8 or HADS-D ≥ 8 at the 1-month assessment) or a stable psychologically stable cohort, the latter included low-level anxiety/depression patients. Analyses included between-group comparisons regar
At the 1-month follow-up, 65 of 168 (38.7%) patients demonstrated clinically significant anxiety-depression. Compared with the control group, the anxiety-depression cohort had a significantly higher 12-month MACE rate (27.7% vs 8.9%, P = 0.003), including increased rates of target lesion revascularization (15.4% vs 4.9%, P = 0.018), repeat myocardial infarction (7.7% vs 1.9%, P = 0.048) and unplanned cardiovascular rehospitalization (20.0% vs 7.8%, P = 0.016). Seventeen (44%) patients experienced anxiety-depression following the procedure; compared to patients without anxiety-depression. Multivariate logistic regression revealed seven independent predictors of post-procedural anxiety-depression: History of prior anxiety-depression [odds ratio (OR) = 3.45, 95% confidence interval (CI): 1.92-6.20, P < 0.001], National Heart, Lung, and Blood Institute type C dissection (OR = 3.12, 95%CI: 1.78-5.47 P < 0.001), elevated high-sensitivity C-reactive protein > 10 mg/L (OR = 2.68, 95%CI: 1.52-4.72, P = 0.001), female sex (OR = 2.35, 95%CI: 1.40-3.95, P = 0.001), residual stenosis > 30% post-DCB (OR = 2.21, 95%CI: 1.28-3.82, P = 0.004), low social support (OR = 2.05, 95%CI: 1.18-3.56, P = 0.011), and procedure duration > 90 minutes (OR = 1.88, 95%CI: 1.08-3.27, P = 0.026). The composite model yielded an area under the curve of 0.86 (95%CI: 0.80-0.92), with sensitivity of 78.5% and specificity of 82.1%.
The interpretable predictive model integrating procedural, inflammatory, and psychosocial predictors provides high discrimination for predicting vulnerable patients within 90 days of hospital discharge. These results provide a basis for the implementation of standardized psychological evaluation as part of post-interventional care pathways among patients with coronary dissection.
Core Tip: Clinically significant anxiety-depression developed in 38.7% of patients following coronary dissection after intravascular ultrasound-guided drug-coated balloon angioplasty, and was independently associated with a nearly threefold higher 12-month major adverse cardiovascular event rate. Seven independent predictors were identified, and a composite model achieved an area under the curve of 0.86, supporting routine psychocardiological screening in this population.