French investigation explores the outcome of physical functioning of coronary angioplasty

A French investigation published in the current issue of Psychotherapy and Psychosomatics has explored the outcome in terms of physical functioning of coronary angioplasty.

Although anxiety and depressive symptoms have been reported to be predictive of poorer functional recovery in coronary heart disease (CHD) patients, little data are available on their effects after percutaneous transluminal coronary angioplasty (PTCA). Alexithymia is a psychological construct that encompasses a deficiency in understanding, processing, or describing emotions. Reports in the literature suggest that alexithymia might be associated with the severity of coronary stenosis in CHD. Furthermore, although alexithymia has also been reported to be associated with poorer quality of life in other illnesses and decreased life satisfaction in CHD patients, there have been no studies investigating its impact on physical functioning in CHD patients undergoing PTCA. The aim of this study was therefore to examine the impact of depressive symptoms, anxiety and alexithymia on physical functioning 6 months after PTCA.

Patients suffering from acute coronary syndrome were admitted to a cardiology ward for coronarography. The decision to perform PTCA was taken during that procedure. Within 24 h of PTCA, one of the investigators informed eligible patients about the study, obtained signed consent from those agreeing to participate and assessed all participants with physical functioning, alexithymia, depressive symptoms and anxiety scales. Background variables were collected from medical charts. Physical functioning was re-assessed at 6 months by telephone interview. During the enrolment period, PTCA was performed on 134 patients, 86 of whom were eventually recruited at baseline (11 not approached, 23 excluded, 14 refusals). Twenty-three patients could not be reached at follow-up and 6 decided to withdraw from the study. A total of 57 subjects therefore completed the follow-up interview at 6 months (dropout rate 33.7%). Alexithymia was assessed using the 20-item Toronto Alexithymia Scale (TAS) and depressive symptoms with the 15-item short version of the Geriatric Depression Scale (GDS). In order to measure anxiety, the investigators used the 20-item self-reported state anxiety subscale of the State Trait Anxiety Inventory (STAI) which has previously produced good results in patients suffering from CHD. The primary outcome variable was the Physical Composite Score (PCS) of the 36-item Short Form health survey. The PCS is a summary scale resulting from a combination of the eight subscales, giving greater weight to those relevant to physical function (physical functioning, role functioning, bodily pain and general heath) and less to those relevant to mental functioning (emotional role, mental health, vitality, social functioning).

Pearson's correlation analyses revealed that 6-month PCS was not associated with any of the background variables (gender, age, living alone, number of dilations, and risk factors, time since CHD diagnosis). It was, however, positively correlated with baseline PCS (r = 0.49, p< 0.01) and negatively with GDS>1,55 =17.18, p<0.01) and explained 23.8% (22.4% adjusted) of the variance. In a second block, the three psychological variables (GDS, STAI, TAS) were added using a stepwise entry mode. The model identified TAS as the only significant psychological predictor of follow-up PCS (F_2,54 =11.58, p<0.05) and revealed a significant increase in the explained variance (R²>

The main original finding from this study is that the presence of alexithymia at the time of PTCA is a unique significant psychological predictor of poorer physical functioning at 6 months. An impaired physical functioning leads to increased visits, rehospitalization and morbidity. Although an association between alexithymia and quality of life has been demonstrated in other somatic diseases, no other data are available for CHD patients. However, despite some studies reporting no association with increased cardiac events after myocardial infarction, alexithymia might be associated with the severity of coronary stenosis. This study also confirms the association between physical function and depression in CHD patients but suggests that alexithymia might be a better predictor than depression.