Anxiety and depression scores in patients with coronary artery disease and coronary artery ectasia

The relation of negative emotions such as depression and anxietywith cardiovascular disease has been reported in numerous studies [1,2]. In patients with stable coronary artery disease (CAD), it has beendemonstrated that depression is a strong predictor of cardiovascularevents [3]. Also, anxiety symptoms are associated with an increasedrisk of death or myocardial infarction among patients with CAD [4].The long term activation of autonomic nervous system may increasethe risk of atherosclerosis, cardiac ischemia, blood pressure variability,heart rate variability, myocardial infarction or sudden death [5].Coro-naryarteryectasia(CAE)islocalizedordiffusedilationofepicardialcor-onary arteries, 1.5 times the diameter of the adjacent normal coronarysegment [6,7]. Although CAE has been supposed to be a variant of ath-erosclerosis, clinical parameters and pathophysiologic processes showconsiderable differences compared to those of obstructive coronary ar-tery disease, which is well reviewed by Yetkin and Waltenberger [8].Recentlywehavedocumentedincreasedanxietyanddepressionscoresin patients with slow coronary flow compared to patients with normalcoronary arteries and normal coronary flow (unpublished data). Ac-cordingly, we aimed to test whether anxiety and depression status ofpatients with CAE are different from those of patients with CAD.We prospectively included 328 patients who had coronary arterydisease. Of whom 310 patients had only CAD and 18 patients had bothCAE and CAD. The patients were individually approached by the regis-terednursesandinvitedtoparticipateinthestudy.Thenursebrieflyex-plained the study and asked patient to complete the questionnaires. Tominimize the environmental factors, the participants were asked to bealoneinasilentroomunlesstheyaskedforhelptoreadorwrite.Allpa-tients were asked to complete the questionnaires including State-TraitAnxiety Inventory (STAI), Beck Depression Inventory (BDI) and BeckAnxiety Inventory (BAI) at least 2 h before coronary angiography. TheSpielberger State-Trait Anxiety Inventory state and trait scores (STAI-Sand STAI-T) were used to characterize anxiety symptoms of the pa-tients. The STAI-S measures the transitional emotional status evokedby a stressful situation, like surgery. The STAI-T score reflects relativelyenduring individual differences in anxiety proneness [9]. The 21-itemBeck Depression Inventory — Version 2 (BDI-2) is a widely used mea-sure of psychological and physical symptoms of depression in adults.Each item consists of four statements indicating the degree of severityofthesymptom.Allpatients'angiographicresultsweretoldimmediate-lyaftertheprocedure.Atleast1hlaterafterthepatientswereinformedabout their coronary artery lesions, they were asked to recompleteSTAI-S. Each set of questionnaires took approximately 15–20 min tocomplete. All of the patients completed the questionnaire on the dayof the coronary angiography. The validity and reliability of the BDI andBAI have been studied in the Turkish Population by Ulusoy and Hisli[10,11].Coronary angiography was performed with standard Seldinger'stechnique by femoral approach in all patients. In order to evaluateeach coronary artery, at least four views from the left and two viewsfromtherightsystemweretaken.Angiographicimageswereevaluatedby two independent researchers. CAE was defined as dilatation of atleastoneepicardialcoronaryartery1.5timesthereferencevesseldiam-eter in any of the coronary arteries. CAD was defined as nonsignificantor significant atherosclerotic lesions in any of the coronary arteries. Pa-tients with known systemic diseases, malignancies, psychiatric disor-ders, acute coronary syndromes and previous coronary angiography orcoronary artery bypass grafting were not included in the study.Continuous variables were given as mean ± S.D.; categorical vari-ables were defined as percentage. Comparison of categorical data was