PURPOSE: This study was done to identify the relationship of expressions of hostility, trait anger, and anger in patients with Coronary Artery Disease (CAD). METHODS: Ninety patients between 30 and 80 who were admitted to A hospital participated in the study. Data were collected through a questionnaire survey using convenience sampling. The research tool consisted of 24 questions by Costa et al (1986) and 10 questions specifically on anger from the Korean version (Chon, Hahn, & Lee, 1998) of the State-Trait Anger Inventory by Spielberger (1988). All of the questions were answered using a 4-point Likert scale. The data were analyzed with SPSS Win version 10.0. RESULTS: Mean scores for hostility, trait anger, anger-out, anger-in, and anger-control were 2.51, 2.19, 1.93, 1.85, and 2.56, respectively. Hostility and trait anger showed a significantly positive correlation to anger-out and anger-in. CONCLUSION: This study presented baseline data that indicate that psychosocial factors are associated with the occurrence and progression of CAD. Accordingly, various programs that include psychological interventions are required to diminish the level of hostility and anger. Also, further studies should be conducted with larger patient populations.
Anger* ; Coronary Artery Disease ; Coronary Disease ; Hostility* ; Humans ; Psychology ; Surveys and Questionnaires

OBJECTIVEWe previously showed that factorial score of somatization, which was obtained by the examination of symptom checklist-90 (SCL-90), was higher in patients received transfemoral coronary catheterization than norm. The aim of the present study was to compare the patient's psychologic status between transradial approach and transfemoral approach percutaneous coronary catheterizations.

METHODSA total of 198 inpatients (105 transfemoral, 93 transradial) underwent scheduled first time coronary catheterizations were enrolled. All patients were studied by symptom SCL-90 on present psychologic status 24 hours before and 24-48 hours after coronary catheterizations.

RESULTSAge, sex, weight, smokers, employment, educational background, marriage status, family relations, family history of cardiovascular disease, income and medical insurance status were similar between the two groups. There was also no difference in diabetes, hypertension history as well as coronary heart disease confirmed by coronary catheterization between the 2 groups. Compared with the status before the procedure, factorial scores of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, global severity index and total positive symptoms were significantly reduced after percutaneous coronary catheterizations (1.50 +/- 0.51 vs. 1.64 +/- 0.53, 1.50 +/- 0.48 vs. 1.67 +/- 0.55, 1.28 +/- 0.41 vs. 1.38 +/- 0.49, 1.42 +/- 0.43 vs. 1.55 +/- 0.53, 1.38 +/- 0.41 vs. 1.58 +/- 0.54, 1.32 +/- 0.35 vs. 1.44 +/- 0.41, 1.38 +/- 0.34 vs. 1.49 +/- 0.42, and 23.08 +/- 17.30 vs. 27.72 +/- 18.79, respectively, P all < 0.05). Scores on somatization, depression and positive symptom severity index were significantly lower in patients received transradial coronary catheterizations than those received transfemoral coronary catheterization approach (1.52 +/- 0.51 vs. 1.62 +/- 0.53, 1.43 +/- 0.54 vs. 1.54 +/- 0.43 and 2.36 +/- 0.66 vs. 2.50 +/- 0.43, respectively, P all < 0.05).

CONCLUSIONPatients' psychologic status improved significantly after percutaneous coronary catheterizations. Improvement on psychologic status is significantly better in patients underwent transradial coronary catheterizations than that underwent transfemoral coronary catheterizations.

Aged ; Angioplasty, Balloon, Coronary ; methods ; psychology ; Coronary Angiography ; psychology ; Coronary Disease ; psychology ; therapy ; Femoral Artery ; Humans ; Middle Aged ; Radial Artery ; Self-Assessment

PURPOSE: The purpose of this descriptive study was to identify the influence of health literacy and health empowerment on health behavior practice in elderly patients with coronary artery disease. METHODS: 239 elderly outpatients older than 65 years of age were included. The data were analyzed with descriptive statistics including independent t-test, ANOVA, and hierarchical regression. RESULTS: Major factors having a significant impact on health behavior practice were health literacy (β=.26, p<.001) and health empowerment (β=.32, p<.001). Health literacy was increased by 4.7% after controlling for general and health-related characteristics. Health empowerment increased by 5.9% after controlling for general and health-related characteristics, and health literacy. The two variables explained 35% of the variance in health behavior practice (F=7.74, p<.001). CONCLUSION: The main findings of this study can be utilized as the foundation for developing programs to promote health empowerment and health behavior practice of the elderly population. Furthermore, the results of the study can also be used to establish health-related strategies.
Aged ; Coronary Artery Disease ; Coronary Vessels ; Health Behavior ; Health Literacy ; Humans ; Outpatients ; Power (Psychology)

BACKGROUND AND OBJECTIVES: A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. SUBJECTS AND METHODS: Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. RESULTS: Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R2=0.092, p=0.004; β= -0.525, R2=0.290, p=0.010). CONCLUSION: No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group.
Cardiology ; Checklist ; Chest Pain* ; Coronary Artery Disease ; Coronary Disease ; Dyspnea ; Exercise Test ; Humans ; Hypochondriasis ; Linear Models ; Outpatients* ; Psychology ; Thorax*

OBJECTIVETo compare the prior coronary angiography (CAG) psychological status in chest pain patients with and without coronary artery disease (CAD).

METHODSNinety-nine patients with chest pain and scheduled for CAG were selected by cluster sampling method. The mental status was measured by Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale-17 (HAMD-17) 24 hours before CAG, and the risk factors for CAD were also determined.

RESULTSThere were 43 patients with HAMA score > or = 14, 18 patients with HAMD-17 score > or = 14 and 16 patients with both scores > or = 14. CAD was diagnosed in 46 patients by CAG. HAMA score was significantly higher in patients without CAD than patients with CAD (14.1 +/- 7.1 vs. 11.1 +/- 6.7, P < 0.05).

CONCLUSIONSIncidences of anxiety and depression were high in chest pain patients prior CAG and incidence of anxiety prior CAG was significantly higher in chest pain patients without CAD compared to chest pain patients with CAD.

Adult ; Aged ; Chest Pain ; diagnostic imaging ; psychology ; Coronary Angiography ; psychology ; Coronary Artery Disease ; psychology ; Cross-Sectional Studies ; Depressive Disorder ; epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Stress, Psychological

This review addresses the importance of psychoneuroimmunology (PNI) studies in understanding the role of acute and chronic psychological stressors on the immune system and development of coronary artery disease (CAD). Firstly, it illustrates how psychological stressors change endothelial function and lead to chemotaxis. Secondly, acute psychological stressors lead to leukocytosis, increased natural killer cell cytotoxicity and reduced proliferative response to mitogens while chronic psychological stressors may lead to adverse health effects. This will result in changes in cardiovascular function and development of CAD. Thirdly, acute and chronic psychological stressors will increase haemostatic factors and acute phase proteins, possibly leading to thrombus formation and myocardial infarction. The evidence for the effects of acute and chronic psychological stress on the onset and progression of CAD is consistent and convincing. This paper also highlights potential research areas and implications of early detection of immunological changes and cardiovascular risk in people under high psychological stress.
Acute-Phase Proteins ; Coronary Artery Disease ; immunology ; psychology ; Humans ; Inflammation ; psychology ; Myocardial Infarction ; immunology ; psychology ; Stress, Psychological ; immunology ; Thrombosis ; immunology ; psychology

PURPOSE: Soluble ST2 (sST2) is an emerging prognostic biomarker in patients with cardiovascular disease (CVD). A recent study showed that sST2 predicted incident hypertension. High sensitive C-reactive protein (hsCRP) has been a widely-used biomarker for risk-stratifying in CVD. We compared the abilities of sST2 and hsCRP to predict high risk coronary artery calcium score (CACS). MATERIALS AND METHODS: The CACS was assessed by cardiac computed tomography, and sST2 was measured in 456 subjects enrolled in the Mapo-gu community cohort. In accordance with the 2013 ACC/AHA guidelines, we defined the high risk CACS group as individuals with a CACS ≥300 Agatston units (AU). RESULTS: There were 99 (21.7%) subjects with a CACS ≥300 AU. There was a strong correlation between log sST2 and log hsCRP (r=0.128, p=0.006), and both log sST2 and log hsCRP showed significant associations with CACS (r=0.101, p=0.031 for sST2, r=0.101, p=0.032 for hsCRP). In net reclassification improvement (NRI) analysis, the NRI for hsCRP over sST2 was significant [continuous NRI 0.238, 95% confidence interval (CI) 0.001–0.474, integrated discrimination index (IDI) 0.022, p=0.035], while the NRI for sST2 over hsCRP was not significant (continuous NRI 0.212, 95% CI -0.255–0.453, IDI 0.002, p=0.269). CONCLUSION: sST2 does not improve net reclassification for predicting a high risk CACS. Using hsCRP provides superior discrimination and risk reclassification for coronary atherosclerosis, compared with sST2.
Atherosclerosis ; C-Reactive Protein* ; Calcium* ; Cardiovascular Diseases ; Cohort Studies* ; Coronary Artery Disease ; Coronary Vessels* ; Discrimination (Psychology) ; Humans ; Hypertension

PURPOSE: Prediction of the proximal right coronary artery (pRCA) through electrocardiography (ECG) is very important because pRCA occlusion has frequently been suspected in right ventricular infarction, which has a high mortality rate. The aim of this study is to investigate characteristic ECG finding of pRCA occlusion distinguishable from mid or distal RCA. METHODS: A review was conducted retrospectively of 630 patients with chest pain in the ED who underwent coronary angiography (CAG) from June 2007 to December 2013 and CAG of 89 among them resulted in only RCA occlusion exempting other coronary vessels. The patients were divided into two groups: subjects with pRCA (n=32) occlusion and below the mid RCA (n=57) occlusion. In each subset, features of ECG were searched and analyzed. RESULTS: ECG of patients with occlusion of the pRCA showed more prominent ST depression in lead I (-0.68 mm vs -0.22 mm, p=0.027) and ST elevation in V1 (0.94 mm vs 0.09 mm, p=0.001) than in the below portion. Both ST depression (< or =0 mm) in I and ST elevation (>0.5 mm) in V1 classified according to cutoff value using Youden index J were closely related to pRCA occlusion other than mid or distal RCA (OR 7.16, p<0.001). CONCLUSION: Discrimination of pRCA occlusion from mid or distal RCA in ECG through ST depression in lead I and ST elevation in lead V1 might be valid as a sentinel of right ventricular infarction.
Chest Pain ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Depression ; Discrimination (Psychology) ; Electrocardiography* ; Humans ; Infarction ; Mortality ; Myocardial Infarction ; Retrospective Studies

BACKGROUND: Although the elderly patients who need coronary revascularization are increasing, the effecti- veness and benefit of percutaneous coronary intervention(PCI) or coronary artery bypass surgery(CABG) in the elderly patients have not been evaluated by using comprehensive geriatric assessment. METHODS: From January 2007 to May 2007, 47 patients aged 65 years or older, who had stable angina with more than one coronary artery stenosis, were included in the current study. Comprehensive geriatric assess- ment, including medical, psychosocial, and functional evaluation, was performed by geriatric team. Patients were managed by medical treatment, PCI or CABG according to the decision of attending physician. One year clinical and laboratory evaluations were performed in all the study patients. RESULTS: Baseline characteristics were not significantly different among the medical treatment, PCI, or CABG group, except the extent of coronary artery disease(p=0.007). In addition, comprehensive geriatric assess- ment showed no difference in the three groups. During the follow-up period, major adverse cardiac events (MACE) were observed in 9 patients including 2 cases of cardiac death. Compared with medical treatment and PCI group, CABG group showed impaired ADL status. ADL independency was significantly impaired in CABG group; medical treatment group(84.6%-->91.7%), PCI group(85.2%-->76.9%), and CABG group(71.4%-->33.3%)(p=0.025). However, there was no other difference in cognition, depression, and nutritional status among the groups. CONCLUSION: Compared with medical treatment and PCI group, patients treated by CABG appeared functional dependency in the elderly patients. Effort to identify the risk factor and vulnerable patients should be emphasized especially in the elderly patients who need CABG.
Activities of Daily Living ; Aged ; Angina, Stable ; Cognition ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Death ; Dependency (Psychology) ; Depression ; Follow-Up Studies ; Geriatric Assessment ; Humans ; Nutritional Status ; Risk Factors

BACKGROUND AND OBJECTIVES: Increasing evidence supports that psychological factors may be related to development of coronary artery disease (CAD). Although psychological well-being, ill-being, and control strategy factors may play a significant role in CAD, rarely have these factors been simultaneously examined previously. We assessed comprehensive psychological factors in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: A total of 85 ACS patients (56 unstable angina, 29 acute myocardial infarction; 52.6+/-10.2 years; M/F=68/17) and 63 healthy controls (48.7+/-6.7 years, M/F=43/20) were included. Socio-demographic information, levels of psychological maladjustment, such as anxiety, hostility, and job stress, health-related quality of life (HRQoL), and primary and secondary control strategy use were collected through self-report questionnaires. RESULTS: There was no significant difference between the ACS group and control group in levels of anxiety, hostility, and job stress. However, ACS patients had significantly lower scores on the general health perception and bodily pain subscales of HRQoL than the control group. The ACS group, as compared with the controls, tended to use primary control strategies more, although not reaching statistical significance by univariate analysis. Multivariate logistic regression analysis after adjusting age and gender identified the physical domain of HRQoL {odds ratio (OR)=0.40}, primary control strategy (OR=1.92), and secondary control strategy (OR=0.53) as independent predictors of ACS. CONCLUSION: Poor HRQoL and primary control strategy, proactive behaviors in achieving ones' goal, may act as risk factors for ACS, while secondary control strategy to conform to current situation may act as a protective factor for ACS.
Acute Coronary Syndrome* ; Angina, Unstable ; Anxiety ; Coronary Artery Disease ; Hostility ; Humans ; Logistic Models ; Myocardial Infarction ; Psychology ; Quality of Life* ; Risk Factors* ; Stress, Psychological ; Surveys and Questionnaires