Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction: A comprehensive review of clinical manifestations and interventions

Table 1 Differential protein expression in post-percutaneous coronary intervention anxiety pathophysiology

Protein/pathway	Regulation	Cell/tissue type	Mechanism	Functional impact	Potential as target
Inflammation-related proteins
IL-6	Increased (high)	Circulating monocytes	Upregulated via NF-κB signaling post-PCI	Enhances systemic inflammatory response, promotes BBB permeability	High (anti-IL-6 antibodies)
TNF-α	Increased (moderate)	Activated macrophages	Activated through TLR4 pathway following myocardial injury	Activates microglia, promotes neuroinflammation	Moderate (TNF inhibitors)
CRP	Increased (very high)	Hepatocytes	Acute phase response to cardiac tissue injury	Correlates with anxiety severity (r = 0.62, P < 0.001)	Low (biomarker only)
ICAM-1	Increased (moderate)	Endothelial cells	Activated by inflammatory cytokines	Facilitates leukocyte infiltration across BBB	Moderate
NLRP3 inflammasome	Increased (moderate)	Cardiac tissue, microglia	Activated by DAMPs released during myocardial injury	Mediates IL-1β production, promotes neuroinflammation	High (NLRP3 inhibitors)
Autonomic regulation proteins
Neuropeptide Y	Increased (high)	Sympathetic neurons	Released with catecholamines during sympathetic activation	Potentiates anxiety, promotes vasoconstriction	Moderate (Y1 antagonists)
α1-adrenergic receptors	Increased (moderate)	Vascular tissue, amygdala	Upregulated in response to chronic sympathetic activation	Enhances peripheral vasoconstriction and amygdala excitability	High (α-blockers)
Muscarinic M2 receptors	Increased (moderate)	Cardiac tissue	Downregulated following autonomic imbalance	Reduces parasympathetic control of heart rate	Moderate (M2 agonists)
COMT enzyme	Increased (moderate)	Prefrontal cortex	Epigenetic modifications following stress exposure	Impairs catecholamine metabolism, sustains arousal	Moderate (COMT enhancers)
β2-adrenergic receptors	Increased (moderate)	Immune cells	Receptor desensitization following chronic activation	Reduces anti-inflammatory effects of β-signaling	High (β-agonists)
HPA axis-related proteins
Glucocorticoid receptor	Increased (moderate)	Hippocampus, PFC	Receptor downregulation following cortisol exposure	Impairs negative feedback of HPA axis	High (GR modulators)
CRH[50]	Increased (moderate)	Paraventricular nucleus	Enhanced expression via CREB phosphorylation	Drives HPA axis hyperactivity	High (CRH antagonists)
FKBP5	Increased (moderate)	Multiple CNS regions	Upregulated by cortisol exposure	Inhibits GR function, promotes HPA axis dysregulation	Moderate
11β-HSD1	Increased (moderate)	Adipose tissue, CNS	Upregulated in response to inflammation	Increases local cortisol regeneration	Moderate (11β-HSD1 inhibitors)
Mineralocorticoid receptor	Increased (moderate)	Hippocampus	Downregulated following chronic stress	Alters HPA axis sensitivity	Moderate (MR agonists)

PCI: Percutaneous coronary intervention; HPA: Hypothalamic-pituitary-adrenal.

Table 2 Psychological interventions for anxiety after percutaneous coronary intervention and their effects/applications in cardiac patients

Sources	Intervention types	Primary targets	Response patterns	Roles/functions	Potential applications
Intervention-based approaches
Psycho-cardiology	Cognitive therapy	Catastrophic interpretations	Increased (moderate)	Correct misattribution of normal post-PCI sensations	Treatment of acute anxiety
	Exposure therapy	Cardiac-related avoidance behaviors	Increased (moderate)	Rebuild self-efficacy and functional capacity	Long-term rehabilitation
	Relaxation training	Autonomic arousal	Increased (moderate)	Reduce physiological markers of anxiety	Acute phase management
	Psychoeducation	Knowledge deficits	Increased (moderate)	Increase understanding of normal recovery process	Prevention of anxiety development
Environmental approaches	A-FLORA-ACS Protocol	Hospital environment	Increased (moderate)/increased (moderate)	Provide positive attentional focus during recovery	Adjunctive treatment
	Sound therapy	Stress hormones	Increased (moderate)	Reduce autonomic arousal and improve sleep quality	Inpatient management
	Guided imagery	Rumination	Increased (moderate)	Redirect attention from cardiac concerns	Self-management tool
Cardiac rehabilitation	Supervised exercise	Physical deconditioning	Increased (moderate)	Counter avoidance behaviors through graded exposure	Comprehensive recovery
	Group-based programs	Social isolation	Increased (moderate)	Normalize experiences through peer support	Cost-effective delivery
	Stress management	Global anxiety	Increased (moderate)	Develop coping strategies for cardiac stressors	Prevention of major adverse cardiovascular event
Domains of anxiety
Physiological anxiety	Biofeedback	Heart rate variability	Increased (moderate)	Improve autonomic regulation	Targeted intervention
	Progressive muscle relaxation	Somatic tension	Increased (moderate)	Reduce physical manifestations of anxiety	Self-management
Cognitive anxiety	CBT protocols	Worry and rumination	Increased (moderate)	Restructure cardiac-related cognitions	Chronic anxiety treatment
	Mindfulness-based interventions	Attentional bias	Increased (moderate)	Develop nonjudgmental awareness of sensations	Therapeutic target
Behavioral anxiety	Activity scheduling	Activity avoidance	Increased (moderate)	Gradual reintroduction of avoided activities	Functional improvement
	Motivational interviewing	Treatment adherence	Increased (moderate)	Enhance engagement with recovery behaviors	Medication adherence
Cardiac-specific anxiety	Heart-focused anxiety treatment	Cardiac vigilance	Increased (moderate)	Reduce hypervigilance to bodily sensations	Specialized protocol
	Cardiorespiratory fitness training	Exercise anxiety	Increased (moderate)	Build confidence in cardiac capacity	Physiological improvement
Special populations
Gender-specific	Women's recovery programs	Caregiving concerns	Increased (moderate)	Address role disruption and dependency fears	Gender-focused care
	Men's cardiac groups	Autonomy threats	Increased (moderate)	Address occupational and self-efficacy concerns	Engagement enhancement
Comorbid depression	Integrated treatment protocols	Anhedonia and anxiety	Increased (moderate)	Target overlapping neurobiological mechanisms	Dual-diagnosis approach
	Behavioral activation	Withdrawal behaviors	Increased (moderate)	Increase positive reinforcement	Treatment resistance
Older adults	Age-adapted protocols	Memory and learning	Increased (moderate)	Accommodate cognitive changes in older patients	Geriatric cardiology
	Social prescribing	Isolation	Increased (moderate)	Connect patients with community resources	Sustainable support

PCI: Percutaneous coronary intervention; CBT: Cognitive behavioral therapy.