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Canadian Journal of Cardiology

Depression and Anxiety Before and After Cardiac Rehabilitation: Comparing Patients With and Without Spontaneous Coronary Artery Dissection

Published:January 13, 2023DOI:https://doi.org/10.1016/j.cjca.2023.01.009
      SCAD, a nonatherosclerotic form of coronary artery disease, occurs when a tear or hematoma occurs in the coronary artery wall, reducing blood flow to the heart, often leading to MI.
      • Hayes S.N.
      • Tweet M.S.
      • Adlam D.
      • et al.
      Spontaneous coronary artery dissection: JACC state-of-the-art review.
      Unlike other forms of acute coronary syndrome (ACS), SCAD disproportionally afflicts women (77%-98% of cases) and patients seldom have traditional cardiovascular risk factors (eg, dyslipidemia or smoking).
      • Hayes S.N.
      • Tweet M.S.
      • Adlam D.
      • et al.
      Spontaneous coronary artery dissection: JACC state-of-the-art review.
      Psychologic triggers are prominent precursors; 56% of patients with SCAD reported precipitative distress, whereas the premorbid psychiatric status of patients with ACS ranges much lower (10%-24%). Burgeoning research indicates that depressed mood and anxiety are also prevalent (up to 71%) after SCAD. These rates are 3 to 4 times higher than in the general population. Assessing and responding to these high distress levels is critical because psychiatric symptoms after MI are known to increase the risk of MI recurrence by 50% and mortality by 3- to 4-fold.
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