Document Detail

Fatigue, depressive symptoms, and hopelessness as predictors of adverse clinical events following percutaneous coronary intervention with paclitaxel-eluting stents.
MedLine Citation:
PMID:  17383497     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We investigated the relative effects of fatigue, depressive symptoms, and hopelessness on prognosis at 2-year follow-up in percutaneous coronary intervention (PCI) patients. METHODS: Consecutively admitted PCI patients (n=534) treated with paclitaxel-eluting stent as the default strategy completed the Maastricht Questionnaire (MQ) at baseline. Apart from an overall vital exhaustion score, the MQ also assesses fatigue (seven items; Cronbach's alpha=.87) and depressive symptoms (seven items; Cronbach's alpha=.83), with hopelessness (one item) comprised in the depressive symptom items. Patients were followed up for adverse clinical events (mortality and nonfatal myocardial infarction) at 2 years. RESULTS: At 2-year follow-up, there were 31 clinical events. In univariable analyses, overall vital exhaustion and depressive symptoms, but not fatigue, were associated with adverse prognosis; in multivariable analysis, depressive symptoms [hazard ratio (HR)=2.69; 95% confidence interval (95% CI)=1.31-5.55] remained the only predictor of clinical outcome. Among the depressive symptoms, hopelessness (HR=3.44; 95% CI=1.65-7.19) was the most cardiotoxic symptom. The incidence of clinical events was higher in the high-hopelessness patients (11% vs. 3%; P=.001) than in the low-hopelessness patients. Hopelessness (HR=3.36; 95% CI=1.58-7.14; P=.002) remained an independent predictor of clinical outcome at 2 years in adjusted analysis. CONCLUSION: Symptoms of depression, but not fatigue, predicted adverse clinical events. Hopelessness was the most cardiotoxic symptom, associated with a more than three-fold risk of clinical events 2 years post-PCI. Screening for hopelessness may lead to the identification of high-risk patients.
Susanne S Pedersen; Johan Denollet; Joost Daemen; Meike van de Sande; Peter T de Jaegere; Patrick W Serruys; Ruud A M Erdman; Ron T van Domburg
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of psychosomatic research     Volume:  62     ISSN:  0022-3999     ISO Abbreviation:  J Psychosom Res     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-26     Completed Date:  2007-07-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376333     Medline TA:  J Psychosom Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  455-61     Citation Subset:  IM    
CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / psychology*
Coated Materials, Biocompatible*
Coronary Disease / mortality,  psychology*,  therapy*
Depression / diagnosis,  psychology*
Fatigue / psychology*
Middle Aged
Myocardial Infarction / mortality,  psychology
Paclitaxel / administration & dosage*
Proportional Hazards Models
Risk Factors
Survival Rate
Reg. No./Substance:
0/Coated Materials, Biocompatible; 33069-62-4/Paclitaxel

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