Post-percutaneous coronary intervention psychological disorders predict poor adherence and cardiovascular events in...

Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention (PCI), despite their potential impact on long-term cardiovascular outcomes.

To evaluate the incidence and prognostic significance of post-PCI psychological disorders in elderly patients with heart failure, and to examine their association with medication adherence and major adverse cardiovascular events (MACE).

This retrospective cohort study included 330 consecutive patients aged ≥ 60 years with heart failure who underwent PCI between 2018 and 2021 at a single center, excluding those with prior psychiatric diagnoses. Psychological status within six months post-discharge was assessed using validated Chinese versions of the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale, and medication adherence was measured by the 8-item Morisky Medication Adherence Scale (MMAS-8) scale. A subset of 145 patients with ≥ 24 months of follow-up were analyzed for MACEs. Multivariate logistic regression and Kaplan-Meier survival analyses were performed.

Post-PCI psychological disorders were identified in 40% of patients, with anxiety (36%), depression (32%), and comorbid symptoms (22%) being most prevalent. Affected patients had lower MMAS-8 scores [median 5 (IQR 4-6) vs 6 (IQR 5-7), P = 0.002] and a higher rate of low adherence (51.5% vs 30.3%, P < 0.001). Among the 145 patients followed longitudinally, MACEs occurred in 17.9%, with 65.4% of events in those with psychological disorders. Psychological disorders (OR = 2.66, 95%CI: 1.11-6.41, P = 0.028) and low adherence (OR = 2.77, 95%CI: 1.17-6.56, P = 0.021) were independently associated with increased MACE risk. Kaplan-Meier analysis showed reduced MACE-free survival in patients with psychological disorders (HR = 2.68, 95%CI: 1.25-5.73; log-rank P = 0.008).

Post-PCI psychological disorders are common in elderly patients with heart failure and independently predict poorer adherence and worse cardiovascular outcomes. Routine psychological assessment and adherence interventions may improve prognosis in this vulnerable population.