EMOTIONAL DISTRESS BEFORE CORONARY-BYPASS GRAFTING LIMITS THE BENEFITS OF SURGERY

Background The inclusion of large, heterogeneous groups of patients fo r coronary bypass grafting (CABG) surgery has resulted in a more mixed treatment outcome. Thus it becomes important to identify patients who are less likely to benefit from surgery or who may require additional support to improve treatment outcome. The aim of the present study wa s to examine whether psychological status measured before CABG can con tribute to prediction of short- and long-term outcomes of the surgery. Methods and Results One hundred seventy-one consecutive patients from two large university hospitals in Stockholm completed a psychosocial questionnaire before being scheduled for surgery. One year after CABG, patients again completed the questionnaire. Follow-vp of medical char ts was conducted during the first 3 years after surgery, All major car diac events (cardiac death, definite myocardial infarction, revascular ization, and unstable angina verified by angiography or myocardial sci ntigraphy) were recorded. Although the overall effect of surgery was e xcellent in the majority of cases, the patients exhibiting a high degr ee of distress (anxiety, depression, and tiredness) before surgery ass essed their status as being much worse both before the operation and a t the 1-year follow-up. Equally important was the fact that patients c onsidered distressed before surgery had significantly higher rates of cardiac events (16%) in the 3-year follow-vp period compared with nond istressed patients (5%) (chi-square = 5.11, degrees of freedom = 1, p < 0.02). Conclusions Systematic evaluation and treatment of emotional distress in the candidates for coronary revascularization may be expec ted to result in more optimal subjective results and a reduction in th e number of serious cardiac events after surgery.