Abstract 3657: Mortality after Coronary Artery Bypass Surgery and Psychosocial Factors: A PreCIS Database Study
Introduction: This study examined the existence of four psychosocial variables prior to CABG and the predictive value of these variables on post CABG mortality.
Study: Study size was 4171 patients admitted to the Cleveland Clinic for CABG, from March 2000 thru Sept. 2006. The mean age was 66.5 and 76 % were men. All patients completed a questionnaire about the presence of a significant amount of four psychosocial variables (life stress, time pressure, anger, and sadness) prior to admission. Patient mortality was measured up to 5 years after the CABG and Kaplan-Meier methods were used to compare the history or no history of the psychosocial variables.
Results: There were 274 reported deaths. In examining each variable separately, life stress (p < 0.001) was associated with a protective effect in mortality as well as time urgency (p < 0.01). A history of anger did not show any effect on subsequent mortality (p = 0.53). A history of sadness conferred no overall mortality over a 5-year follow-up period (p = 0.16), but was statistically predictive for mortality between 30 days and 3 years, with peak mortality significance at 1-year follow-up (p < 0.001). Controlling for conventional risk factors, multivariate regression analysis indicated that patients with significant amount of sadness prior to CABG had a 2 X increase in mortality. (HR 2.19) CI (1.47, 3.27). Endorsing significant amount of life stress and time pressure prior to admission was associated with ½ the risk of mortality. (HR 0.59) CI (0.42, 0.83), (HR 0.52) CI (0.28, 0.97). Anger as a psychosocial factor did not appear to statistically affect mortality. (HR of 1.1), CI (0.62,1.85).
Conclusion: A presence of life stress and time urgency prior to CABG tended to have a protective effect in follow-up mortality while the presence of anger had no effect. Conversely, the presence of sadness appeared to have an early detrimental effect on mortality, perhaps corroborating the mortality effect of depression in CABG. Our findings may also validate previous characteristics of “Type A” personality as not being detrimental to CAD patients. Future studies are needed to better psychosocially screen and follow CABG patients and possibly intervene in those at risk populations.