Post-percutaneous coronary intervention psychological disorders predict poor adherence and cardiovascular events in elderly heart failure patients

Table 1 Baseline characteristics of elderly heart failure patients without preexisting psychological disorders, stratified by psychological disorder status within 6 months after percutaneous coronary intervention

Variable	Psychological disorder (n = 132)	No disorder (n = 198)	Statistical method (test statistic)	P value
Age, years	74 (69-79)	72 (68-76)	Mann-Whitney U = 10985.5	0.041
Male, n (%)	66 (50.0)	120 (60.6)	χ2 = 3.22	0.072
BMI, kg/m2	24.8 (23.1-27.0)	25.1 (23.4-26.8)	Mann-Whitney U = 12576.0	0.488
Systolic BP, mmHg	132 (124-145)	134 (126-144)	Mann-Whitney U = 12791.5	0.278
Diastolic BP, mmHg	78 (70-84)	80 (72-85)	Mann-Whitney U = 12134.0	0.118
Hypertension, n (%)	94 (71.2)	134 (67.7)	χ2 = 0.42	0.514
Diabetes mellitus, n (%)	58 (43.9)	64 (32.3)	χ2 = 4.47	0.034
LVEF, %	45 (38-50)	48 (41-53)	Mann-Whitney U = 10592.0	0.021
NT-proBNP, pg/mL	1200 (850-2200)	980 (620-1880)	Mann-Whitney U = 11840.5	0.062
eGFR, mL/min/1.73 m2	68 (52-78)	72 (60-82)	Mann-Whitney U = 10891.5	0.038
BUN, mmol/L	7.5 (5.6-9.3)	7.2 (5.5-8.8)	Mann-Whitney U = 12440.0	0.234
LDL-C, mmol/L	2.6 (2.2-3.2)	2.5 (2.0-3.0)	Mann-Whitney U = 12641.0	0.198
HbA1c, %	6.6 (5.9-7.4)	6.4 (5.8-7.1)	Mann-Whitney U = 12403.5	0.143
AST, U/L	28 (21-36)	25 (20-34)	Mann-Whitney U = 12777.0	0.186
ALT, U/L	29 (22-38)	27 (20-35)	Mann-Whitney U = 12641.5	0.192
Multivessel disease, n (%)	62 (47.0)	78 (39.4)	χ2 = 1.71	0.191
Number of stents placed	2 (1-3)	2 (1-3)	Mann-Whitney U = 12901.5	0.466
CK-MB, U/L	38 (24-56)	36 (22-54)	Mann-Whitney U = 12376.0	0.291
NYHA class ≥ III, n (%)	38 (28.8)	42 (21.2)	χ2 = 2.67	0.103
Killip class ≥ II, n (%)	21 (15.9)	20 (10.1)	χ2 = 2.47	0.116
Hospital stay, days	9 (7-11)	8 (6-10)	Mann-Whitney U = 10687.0	0.047

Values are presented as median (IQR) for continuous variables and n (%) for categorical variables. Psychological disorders include clinically diagnosed or screening-confirmed depression, anxiety, or adjustment disorders occurring within 6 months post-percutaneous coronary intervention. P values were calculated using the χ² test for categorical variables and the Mann-Whitney U test for continuous variables. BMI: Body mass index; BP: Blood pressure; LVEF: Left ventricular ejection fraction; NT-proBNP: N-terminal pro-B-type natriuretic peptide; eGFR: Estimated glomerular filtration rate; LDL-C: Low-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin; CK-MB: Creatine kinase-MB; NYHA: New York Heart Association; BUN: Blood urea nitrogen; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.

Table 2 Psychological and behavioral characteristics of patients stratified by post- percutaneous coronary intervention psychological disorder status, n (%)

Variable	Psychological disorder group (n = 132)	No psychological disorder group (n = 198)	Statistical test (value)	P value
PHQ-9 score	13 (10-16)	4 (2-7)	Mann-Whitney U = 2810.5	< 0.001
GAD-7 score	12 (9-15)	3 (1-5)	Mann-Whitney U = 2952.0	< 0.001
PSQI (sleep quality index)	9 (6-13)	6 (4-9)	Mann-Whitney U = 3781.0	< 0.001
Social support score (SSRS)	18 (12-22)	16 (11-20)	Mann-Whitney U = 11224.5	0.033
Cognitive complaints	47 (35.6)	18 (9.1)	χ2 = 28.47	< 0.001
Psychiatric consultation	28 (21.2)	3 (1.5)	χ2 = 37.53	< 0.001
Antidepressant use	24 (18.2)	2 (1.0)	χ2 = 31.16	< 0.001
Anxiolytic use	31 (23.5)	7 (3.5)	χ2 = 40.04	< 0.001
Living alone	40 (30.3)	32 (16.2)	χ2 = 9.45	0.002
Recent life stress	29 (22.0)	14 (7.1)	χ2 = 15.71	< 0.001
Past depression history	8 (6.1)	1 (0.5)	χ2 = 7.04	0.008
Past anxiety history	10 (7.6)	2 (1.0)	χ2 = 5.18	0.023
Family psychiatric history	16 (12.1)	4 (2.0)	χ2 = 8.00	0.005
Current smoking	38 (28.8)	50 (25.3)	χ2 = 0.22	0.641
Alcohol use	34 (25.8)	42 (21.2)	χ2 = 0.74	0.389

PSQI: Pittsburgh Sleep Quality Index; PHQ-9: Patient Health Questionnaire-9; GAD-7: Generalized Anxiety Disorder-7; SSRS: Social Support Rating Scale.

Table 3 Medication adherence (8-item Morisky Medication Adherence Scale) in patients with and without post-percutaneous coronary intervention psychological disorders (n = 330), n (%)

Variable	Psychological disorder group (n = 132)	No psychological disorder group (n = 198)	Statistical test (value)	P value
MMAS-8 score	5 (4-6)	6 (5-7)	Mann-Whitney U = 7386.0	0.002
High adherence (8)	25 (18.9)	73 (36.9)	χ2 = 10.88	0.001
Medium adherence (6-7)	39 (29.5)	65 (32.8)	χ2 = 0.34	0.560
Low adherence (< 6)	68 (51.5)	60 (30.3)	χ2 = 14.21	< 0.001

MMAS-8: 8-item Morisky Medication Adherence Scale.

Table 4 Characteristics of patients with and without major adverse cardiovascular event during 2-year follow-up (n = 145), n (%)

Variable	MACE group (n = 26)	Non-MACE group (n = 119)	Statistical test (value)	P value
Age ≥ 70 years	17 (65.4)	54 (45.4)	χ2 = 3.18	0.074
Female	11 (42.3)	38 (31.9)	χ2 = 1.38	0.240
Diabetes mellitus	15 (57.7)	37 (31.1)	χ2 = 6.62	0.010
LVEF < 45	14 (53.8)	34 (28.6)	χ2 = 5.75	0.017
eGFR < 60	13 (50.0)	28 (23.5)	χ2 = 6.77	0.009
Post-PCI psychological disorder	17 (65.4)	39 (32.8)	χ2 = 8.67	0.003
MMAS-8 < 6 (low adherence)	18 (69.2)	43 (36.1)	χ2 = 9.92	0.002

PCI: Percutaneous coronary intervention; MMAS-8: 8-item Morisky Medication Adherence Scale; MACE: Major adverse cardiovascular event; LVEF: Left ventricular ejection fraction; eGFR: Estimated glomerular filtration rate.

Table 5 Multivariate logistic regression for predicting 2-year major adverse cardiovascular event after percutaneous coronary intervention (n = 145)

Variable	β (coefficient)	OR (95%CI)	P value
Psychological disorder (yes vs no)	0.98	2.66 (1.11-6.41)	0.028
MMAS-8 < 6 (low adherence vs high/medium)	1.02	2.77 (1.17-6.56)	0.021
Age ≥ 70 years	0.56	1.75 (0.76-4.02)	0.184
Diabetes mellitus	0.61	1.84 (0.81-4.18)	0.144
LVEF < 45%	0.74	2.10 (0.94-4.70)	0.073
eGFR < 60	0.68	1.97 (0.85-4.57)	0.118
Female sex	0.29	1.34 (0.58-3.13)	0.497

MMAS-8: 8-item Morisky Medication Adherence Scale; LVEF: Left ventricular ejection fraction; eGFR: Estimated glomerular filtration rate.