Anxiety-depression after intravascular ultrasound-guided drug-coated balloon angioplasty dissection: Predictors and 12-month cardiovascular outcomes

Table 1 Baseline demographic and clinical characteristics, n (%)/mean ± SD

Characteristic	Anxiety-depression cohort (n = 65)	Stable cohort (n = 103)	P value
Age (years)	62.8 ± 10.5	64.5 ± 11.2	0.308
Female	34 (52.3)	34 (33.0)	0.013
BMI (kg/m2)	25.2 ± 3.1	24.8 ± 3.4	0.425
Current smoker	22 (33.8)	38 (36.9)	0.683
Hypertension	38 (58.5)	55 (53.4)	0.520
Diabetes mellitus	18 (27.7)	22 (21.4)	0.343
Hyperlipidemia	28 (43.1)	40 (38.8)	0.581
Prior MI	10 (15.4)	12 (11.7)	0.482
Prior PCI	15 (23.1)	20 (19.4)	0.566
Psychiatric history	12 (18.5)	4 (3.9)	0.002
Family psychiatric history	6 (9.2)	3 (2.9)	0.081
SSRS score	30.5 ± 8.2	41.2 ± 7.8	< 0.001
Pre-procedural HADS-A	8.2 ± 3.5	4.8 ± 2.2	< 0.001
Pre-procedural HADS-D	7.5 ± 3.2	4.2 ± 1.9	< 0.001
Pre-procedural GAD-7	9.0 ± 3.8	5.2 ± 2.5	< 0.001
Pre-procedural PHQ-9	8.5 ± 3.5	4.8 ± 2.2	< 0.001
LVEF (%)	55.2 ± 8.5	57.8 ± 7.2	0.105

BMI: Body mass index; MI: Myocardial infarction; PCI: Percutaneous coronary intervention; SSRS: Social Support Rating Scale; HADS: Hospital Anxiety and Depression Scale; GAD-7: Generalized Anxiety Disorder-7; PHQ-9: Patient Health Questionnaire-9; LVEF: Left ventricular ejection fraction.

Table 2 Procedural and dissection characteristics, n (%)/mean ± SD

Parameter	Anxiety-depression cohort (n = 65)	Stable cohort (n = 103)	P value
Target vessel			0.425
LAD	28 (43.1)	42 (40.8)
LCx	15 (23.1)	25 (24.3)
RCA	22 (33.8)	36 (35.0)
Multi-vessel disease	25 (38.5)	32 (31.1)	0.318
Lesion length (mm)	22.5 ± 8.2	20.8 ± 7.5	0.172
Reference diameter (mm)	2.85 ± 0.52	2.92 ± 0.48	0.362
DCB diameter (mm)	2.88 ± 0.50	2.95 ± 0.45	0.345
Pre-dilatation	52 (80.0)	78 (75.7)	0.514
Procedure time (minutes)	95.2 ± 28.5	72.5 ± 22.0	< 0.001
Contrast volume (mL)	185 ± 52	158 ± 42	0.012
NHLBI dissection type			0.003
Type A	18 (27.7)	45 (43.7)
Type B	24 (36.9)	42 (40.8)
Type C	16 (24.6)	12 (11.7)
Type D	5 (7.7)	3 (2.9)
Type E	2 (3.1)	1 (1.0)
Type F	0	0
Dissection length on IVUS (mm)	12.8 ± 4.5	8.2 ± 3.2	< 0.001
Circumferential arc (°)	125 ± 38	85 ± 28	< 0.001
Medial involvement	18 (27.7)	10 (9.7)	0.002
Intramural hematoma	12 (18.5)	8 (7.8)	0.035
Residual stenosis (%)	32.5 ± 10.8	22.8 ± 8.5	< 0.001
Residual MLA (mm2)	4.8 ± 1.2	5.5 ± 1.0	0.002

LAD: Left anterior descending artery; LCx: Left circumflex artery; RCA: Right coronary artery; DCB: Drug-coated balloon; NHLBI: National Heart, Lung, and Blood Institute; IVUS: Intravascular ultrasound; MLA: Minimum lumen area.

Table 3 Twelve-month clinical outcomes, n (%)

Endpoint	Anxiety-depression cohort (n = 65)	Stable cohort (n = 103)	P value
Composite MACE	18 (27.7)	9 (8.7)	0.002
Cardiac death	3 (4.6)	2 (1.9)	0.247
Non-fatal MI	5 (7.7)	2 (1.9)	0.048
Target lesion revascularization	10 (15.4)	5 (4.9)	0.018
Target vessel revascularization	12 (18.5)	7 (6.8)	0.022
Unplanned CV rehospitalization	13 (20.0)	8 (7.8)	0.016
All-cause mortality	4 (6.2)	3 (2.9)	0.272
Stroke/TIA	2 (3.1)	1 (1.0)	0.340
New-onset heart failure	5 (7.7)	3 (2.9)	0.141
Recurrent angina (CCS ≥ II)	18 (27.7)	12 (11.7)	0.006

MACE: Major adverse cardiovascular events; MI: Myocardial infarction; CV: Cardiovascular; TIA: Transient ischemic attack; CCS: Canadian Cardiovascular Society.

Table 4 Laboratory biomarkers on post-procedural day 14, mean ± SD

Biomarker	Anxiety-depression cohort (n = 65)	Stable cohort (n = 103)	P value
hs-CRP (mg/L)	12.8 ± 4.5	6.2 ± 2.8	< 0.001
IL-6 (pg/mL)	9.5 ± 3.2	5.2 ± 1.8	< 0.001
TNF-α (pg/mL)	15.2 ± 4.0	9.8 ± 2.5	< 0.001
NLR	4.8 ± 1.6	2.9 ± 1.1	< 0.001
Fibrinogen (g/L)	4.2 ± 0.8	3.5 ± 0.6	< 0.001
Peak hs-TnI (ng/mL)	0.85 ± 0.32	0.42 ± 0.18	< 0.001
NT-proBNP (pg/mL)	385 ± 125	245 ± 88	< 0.001
Peak CK-MB (U/L)	28.5 ± 10.2	18.2 ± 6.5	< 0.001
Morning cortisol (nmol/L)	418 ± 98	325 ± 72	< 0.001
ACTH (pg/mL)	42.5 ± 9.2	35.2 ± 7.0	< 0.001
Homocysteine (μmol/L)	16.8 ± 5.5	12.2 ± 3.8	< 0.001
HbA1c (%)	6.5 ± 1.2	6.2 ± 1.0	0.082
LDL-C (mmol/L)	2.85 ± 0.82	2.72 ± 0.75	0.385
HDL-C (mmol/L)	1.02 ± 0.25	1.18 ± 0.28	0.012

hs-CRP: High-sensitivity C-reactive protein; IL-6: Interleukin-6; TNF-α: Tumor necrosis factor-α; NLR: Neutrophil-to-lymphocyte ratio; hs-TnI: High-sensitivity troponin I; NT-proBNP: N-terminal pro-B-type natriuretic peptide; CK-MB: Creatine kinase-MB; ACTH: Adrenocorticotropic hormone; HbA1c: Glycated hemoglobin; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol.

Table 5 Independent predictors of post-procedural anxiety-depression on multivariate logistic regression

Variable	β	SE	Wald	OR (95%CI)	P value
Prior anxiety-depression history	1.238	0.300	17.02	3.45 (1.92-6.20)	< 0.001
Type C dissection	1.138	0.286	15.82	3.12 (1.78-5.47)	< 0.001
hs-CRP > 10 mg/L	0.986	0.290	11.56	2.68 (1.52-4.72)	0.001
Female sex	0.855	0.265	10.40	2.35 (1.40-3.95)	0.001
Residual stenosis > 30%	0.793	0.280	8.02	2.21 (1.28-3.82)	0.004
Low social support (SSRS < 35)	0.718	0.282	6.48	2.05 (1.18-3.56)	0.011
Procedure time > 90 minutes	0.631	0.283	4.97	1.88 (1.08-3.27)	0.026
Candidate variables not retained
Diabetes mellitus	0.482	0.289	2.78	1.62 (0.92-2.85)	0.092
Multi-vessel disease	0.438	0.290	2.28	1.55 (0.88-2.73)	0.128
Age > 65 years	0.351	0.280	1.57	1.42 (0.82-2.46)	0.210
Hypertension	0.300	0.280	1.15	1.35 (0.78-2.34)	0.282
Smoking history	0.247	0.272	0.82	1.28 (0.75-2.18)	0.362

OR: Odds ratio; CI: Confidence interval; hs-CRP: High-sensitivity C-reactive protein; SSRS: Social Support Rating Scale.

Table 6 Clinical and biomarker parameters stratified by anxiety-depression severity, mean ± SD

Parameter	Mild (n = 28)	Moderate (n = 24)	Severe (n = 13)	P for trend
HADS-A score	9.5 ± 1.2	13.0 ± 1.5	17.8 ± 2.0	< 0.001
HADS-D score	9.0 ± 1.0	12.5 ± 1.2	17.2 ± 2.2	< 0.001
12-month MACE (%)	17.9	33.3	46.2	0.005
TLR (%)	10.7	16.7	23.1	0.028
Recurrent angina (%)	17.9	29.2	46.2	0.008
hs-CRP (mg/L)	9.8 ± 3.5	13.5 ± 4.2	16.5 ± 5.2	< 0.001
IL-6 (pg/mL)	7.8 ± 2.5	10.2 ± 3.0	12.8 ± 3.8	< 0.001
Peak hs-TnI (ng/mL)	0.68 ± 0.25	0.88 ± 0.30	1.05 ± 0.38	0.002
NT-proBNP (pg/mL)	325 ± 105	395 ± 120	475 ± 145	0.003
Morning cortisol (nmol/L)	385 ± 85	425 ± 95	465 ± 115	0.005
NLR	4.0 ± 1.2	4.8 ± 1.5	5.8 ± 1.8	0.002
SSRS score	33.2 ± 7.5	29.5 ± 8.0	26.8 ± 6.5	0.008
EQ-5D VAS	65.2 ± 10.5	55.8 ± 11.2	48.5 ± 12.0	< 0.001
Medication adherence (%)	82.5 ± 8.5	72.8 ± 10.2	62.5 ± 12.5	< 0.001
Cardiac rehabilitation participation (%)	71.4	54.2	30.8	0.002

HADS: Hospital Anxiety and Depression Scale; MACE: Major adverse cardiovascular events; TLR: Target lesion revascularization; hs-CRP: High-sensitivity C-reactive protein; IL-6: Interleukin-6; hs-TnI: High-sensitivity troponin I; NT-proBNP: N-terminal pro-B-type natriuretic peptide; NLR: Neutrophil-to-lymphocyte ratio; SSRS: Social Support Rating Scale; EQ-5D VAS: EuroQol five-dimension visual analogue scale.