Clinical outcome and emotional-behavioural status after isolated coronary surgery

Abstract

In order to evaluate clinical and psychosocial results of isolated coronary artery by-pass graft (CABG) we studied 626 consecutive patients, mean age 61±8 years (86% men), in a follow-up (median: 58 months) with a complete questionnaire about cardiosurgical problems (post-operative vital status, angine relapse, infarction, heart failure, PTCA, redo, PM) and psychosocial variables (mood, irritableness, job satisfaction, hobby satisfaction, family relations, sexual activity, general well-being and work status). Global evaluation improvement of psychosocial variables was found in 71% of patients without cardiac events (group A) and 11% of patients with cardiac events (group B); worsening was found in 2% of group A and 1% of group B; no referred variations in 13% and 2% respectively (p≤0.05. Interests (in work, hobbies and sexual activities) demonstrate an improvement in 20% (group A) and 2% (group B); worsening in 12% (group A) and 4% (group B); no variations in 51% (group A) and 11% (group B) (p≤0.005). Patients reported a well-being evaluation improvement about 66% in the group returning to work without restriction, 13% in those with limitation, 6% no further working; worse or unchanged well-being evaluation was found in 9% of patients returning to work without restriction, 3% with limitation, 3% no further working (p≤0.001). In the last 2 years we have collected pre-operative and post-operative data in a sample of 58 patients by using standardized self-evaluated rating scales about state and trait anxiety (STAI X1, STAI X2), depression (ZUNG) and quality of life, examining social relationships, interests and affective disturbances. Trait anxiety had no change (T0=38.69±9.20 vs. T1=38.75±9.90; n.s.); state anxiety improved (T0=41.20±9.30 vs. T1=38.34±9.68;p≤0.018); depression had significantly worsened (T0=37.90±7.59 vs. T1=46.65±4.75;p≤0.0005). No statistical differences emerged between pre-operative and post-operative self-evaluation of the quality of life. Cardiac events were reported in 7 out of 58 patients (group B: 12%); these patients were characterized by significantly higher levels of state anxiety than group A patients at the pre-operative evaluation (group A: 39.9±8.2; group B: 49.6±11.8;t=0.933; df=56;p≤0.005) and at the post-operative evaluations (group A: 36.7±8.4; group B: 48.7±11.4;t=−3.6; df=56;p≤0.001). The trait anxiety was significantly lower at the postoperative control in the group A patients than in the group B (group A: 37.5±9.3; group B: 46.9±10.5;t=−2.602; df=56;p≤0.012). The pre-operative depression of group B was higher than group A (group A: 37.1±7.6; group B: 43.1±5.5;t=−2.155; df=56;p≤0.035). The discordance between the improvement of subjective global evaluation versus the worsening of depression (ZUNG Scale) can be related to the importance of physical improvement as much as to some psychosocial variables. Further hypotheses can be represented by the influence of a short pre-operative period in our institution (maximum 30 days) on anxiety and depression levels, the difference between pre-surgical and post-surgical expectations, the removal of pre-operative psychological state; the stress related to psychosocial reintegration etc. In our opinion, taking into consideration the results of the sample of 58 patients, a high level of pre-operative state anxiety and depression and a post-operative higher status of anxiety could be considered as a possible predictor of functional cardiac complications.