p.59 抽出テキスト
Lawton et al 2021 ACC/AHA/SCAI Coronary Revascularization Guideline January 18, 2022 Circulation. 2022;145:e18–e114. DOI: 10.1161/CIR.0000000000001038 e76 CLINICAL STATEMENTS AND GUIDELINES 15.3 Psychological Interventions in Patients After Revascularization Recommendations for Psychological Interventions in Patients After Revascularization Referenced studies that support the recommendations are summarized in Online Data Supplement 51. COR LOE Recommendations 1 B-R 1. In patients who have undergone coronary revascularization who have symptoms of depression, anxiety, or stress, treatment with cognitive behavioral therapy, psychological counseling, and/or pharmacological interventions is beneficial to improve quality of life and cardiac outcomes.1-7 2b C-LD 2. In patients who have undergone coronary revascularization, it may be reasonable to screen for depression and refer or treat when it is indicated to improve quality of life and recovery.8,9 Synopsis Cardiac events and coronary revascularization can be distressing life events that lead to psychosocial morbidity.10-13 Anxiety, depression, and stress are associated with poor adherence to healthy behaviors and prescribed medications, compromised quality of life, increased health care costs, and increased recurrent cardiac events12,14-18 and are independent risk factors for CVD morbidity and mortality19-24 (Figure 8). Presurgery estimates of depression in patients undergoing CABG range from 14% to 43%,23,25-27 and depression increases length of hospital stay28 and mortality rate.14,23,29 About 20% of patients who undergo CABG remain depressed postoperatively.30 Several psychological therapies have been used as part of secondary prevention to improve psychological outcomes. These include relaxation and stress management, enhancement of coping skills, and cognitive behavioral therapy, many of which are incorporated into cardiac rehabilitation programs.3,31 Recommendation-Specific Supportive Text 1. In the EsDEPACS (Escitalopram for Depression in Acute Coronary Syndrome) trial, escitalopram was superior to placebo in reducing depression during the 24-week trial.32 Long-term follow-up showed that escitalopram resulted in a significantly lower risk of MACE and MI but not death.2 The ENRICHD (Enhancing Recovery in Coronary Heart Disease Patients) trial demonstrated that therapy with counseling or selective serotonin reuptake inhibitors was associated with improved depression but not event-free survival after 24 months of follow-up.5 A subgroup analysis of this study, however, found a 42% lower risk of death or MI in patients treated with a selective serotonin reuptake inhibitor.33 The Bypassing the Blues trial randomized depressed patients undergoing CABG to 8 months of collaborative care or usual care and demonstrated a 50% reduction in depression scores and improved quality of life in the collaborative care group.7,34 A meta-analysis of these trials reported a reduction in cardiovascular deaths but not overall deaths, MI, or revascularization with psychological interventions.1 These interventions also improved depression, anxiety, and stress as compared with controls.1 2. Depression remains an important comorbidity after revascularization, and treatment options are underused. On the basis of observational data and the availability of effective depression treatments,35 multiple professional societies recommend depression screening for patients with ACS, followed by treatment when depression is identified.8,19,36,37 Programs combining depression screening, with support systems in place, improve clinical outcomes in adults.1 However, in the CODIACS-QoL (Comparison of Depression Interventions After Acute Coronary Syndrome: Quality of Life) trial evaluating 1500 patients with ACS without a history of depression, providing universal depression screening and notifying treating clinicians of positive results of screening, either with or without provision of enhanced depression care, did not alter quality of life, depressionfree days, depressive symptoms, mortality rate, or patient-reported harms in patients with ACS.9 In this trial, a smaller-than-expected proportion of patients with screening were found to have depression. 16 REVASCULARIZATION OUTCOMES 16.1 Assessment of Outcomes in Patients After Revascularization Recommendations for Assessment of Outcomes in Patients After Revascularization Referenced studies that support the recommendations are summarized in Online Data Supplement 52. COR LOE Recommendations 1 B-NR 1. With the goal of improving patient outcomes, it is recommended that cardiac surgery and PCI programs participate in state, regional, or national clinical data registries and receive periodic reports of their risk-adjusted outcomes as a quality assessment and improvement strategy.1-8 2a C-LD 2. With the goal of improving patient outcomes, it is reasonable for cardiac surgery and PCI programs to have a quality improvement program that routinely 1) reviews institutional quality programs and outcomes, 2) reviews individual operator outcomes, 3) provides peer review of difficult or complicated cases, and 4) performs random case reviews.9,10 2b C-EO 3. Smaller volume cardiac surgery and PCI programs may consider affiliating with a highvolume center to improve patient care. Downloaded from http://ahajournals.org by on October 7, 2026