Cardiovascular risk profile before coronary artery bypass graft surgery in relation to depression and anxiety disorders: An age and sex propensity matched study

Objective: The cardiovascular risk profile and postoperative morbidity outcomes of anxiety disorder patients undergoing coronary artery bypass surgery is not known. Methods: In a cross-sectional design, 114 consecutive coronary artery bypass graft surgery patients were evaluated to create four matched groups (30 with anxiety disorder, 27 with depression disorder and 57 age-sex matched coronary artery bypass surgery control patients with no depression or anxiety disorder). Results: By comparison to non-depression disorder age-sex matched controls, depressed patients presented for coronary artery bypass surgery with significantly greater myocardial inflammatory markers (Troponin T > 02, 33.3% vs. 11.1%, p = .03), metabolic risk (body surface area > 35 (22.2% vs. 0%, p = .03), comorbid cardiovascular risk (peripheral vascular disease 18.5% vs. 0%, p = .05). Depressed patients also recorded longer intraoperative time at higher temperatures >37 degrees C on cardiopulmonary bypass (11.1 +/- 9.0 vs. 6.0 +/- 4.9, p < 005) and had higher maximum postoperative Troponin T (.44 +/- .2 vs..28 +/- .1, p = .03). Patients with anxiety disorder on the other hand presented with significantly higher Creatinine Kinase-Muscle Brain (5 IQR 4-5 ng/ml vs. 4 IQR 3-4 ng/ml, p = .04), higher intraoperative glucose levels (7.8 +/- 2.5 mmol/l vs. 7.0 +/- 1.2 mmol/l, p = .05), and received fewer grafts (2.1 +/- .9 vs. 2.5 +/- .9 p = .04). Conclusions: A differential cardiovascular risk profile and postoperative outcome was observed dependent on anxiety and depression disorder status. There were few modifiable cardiovascular risk factors at the time of surgery other than psychiatric status, perioperative management of depression and anxiety may have promise to reduce further cardiac morbidity after coronary artery bypass surgery. Crown Copyright (C) 2014 Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd) on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved.