Association between acute and chronic life events on acute coronary syndrome: a case-control study.

BACKGROUND AND OBJECTIVES: Some studies have shown that acute and chronic psychological stressors are associated with acute coronary syndromes (ACSs). The aim of the present study was to assess the association between acute and chronic psychological stressors and ACS in an Iranian population. METHOD: In an age-sex frequency-matched, case-control study, 78 hospitalized patients with ACS as the case group were compared with 146 patients with chronic stable angina (CSA) as the control group. Chronic stable angina was confirmed by positive angiographic findings. Acute stressors were examined through a semistructured interview and the acute life event checklist, regarding stressful events during 48 hours before interview. To assess chronic stress, the occurrence of 46 stressful events in a period of 6 months prior to the interview was examined using the stress inventory questionnaire. RESULTS: The average acute stressor counts were 4.80 (SD, 2.87) and 3.97 (SD, 2.2) in ACS and CSA groups, respectively (P = .028). Chronic stressor counts were 9.91 (SD, 5.86) and 6.58 (SD, 3.16) in case and control groups (<.001), respectively. Odds ratios for acute and chronic stressor counts were 1.14 (95% confidence interval [95% CI], 1.02-1.28) and 1.84 (95% CI, 1.10-1.26), respectively; when the associations were adjusted for traditional risk factors, they become 1.12 (95% CI, 0.99-1.27) and 1.20 (95% CI, 1.10-1.30), respectively. CONCLUSION: Acute stress did not contribute significantly in the models including chronic stress. Acute stressful events in the recent 48 hours, independent of traditional risk factors, can have a triggering effect on ACS occurrence. Nevertheless, this happens in the context of high chronic stress. In addition, chronic stress count was moderately associated with ACS even when it was adjusted for traditional risk factors (ALEACE study).

Association of socioeconomic status and life-style factors with coping strategies in Isfahan Healthy Heart Program, Iran.

AIM: To investigate the association between life-style and socioeconomic factors and coping strategies in a community sample in Iran. METHOD: As part of a community-based study called Isfahan Healthy Heart Program, we studied 17593 individuals older than 19 living in the central part of Iran. Demographic and socioeconomic factors (age, sex, occupation status, marital status, and educational level) and lifestyle variables (smoking status, leisure time physical activity, and psychological distress), and coping strategy were recorded. Data were analyzed by Pearson correlation and multiple linear regression. RESULTS: Not smoking (women beta=-11.293, P<0.001; men beta=-3.418, P=0.007), having leisure time physical activity (women beta=0.017, P=0.046; men beta=0.005, P=0.043), and higher educational level (women beta=0.344, P=0.015; men beta=0.406, P=0.008) were predictors of adaptive coping strategies, while smoking (women beta=11.849, P<0.001; men beta=9.336, P<0.001), high stress level (women beta=1.588, P=0.000; men beta=1.358, P<0.001), and lower educational level (women beta=-0.443, P=0.013; men beta=-0.427, P=0.013) were predictors of maladaptive coping strategies in both sexes. Non-manual work was a positive predictor of adaptive (beta=4.983, P<0.001) and negative predictor of maladaptive (beta=-3.355, P=0.023) coping skills in men. CONCLUSION: Coping strategies of the population in central Iran were highly influenced by socioeconomic status and life-style factors. Programs aimed at improving healthy life-styles and increasing the socioeconomic status could increase adaptive coping skills and decrease maladaptive ones and consequently lead to a more healthy society.

Early chest tube removal after coronary artery bypass graft surgery.

BACKGROUND: There is no clear data about the optimum time for chest tube removal after coronary artery bypass surgery. AIM: The aim of this study was to assess the impact of the chest tube removal time following coronary artery bypass grafting surgery on the clinical outcome of the patients. MATERIAL AND METHODS: An analysis of data from 307 patients was performed. The patients were randomized into two groups: in group 1 (N=107) chest tubes were removed within the first 24 hours after surgery, whereas in group 2 (N=200), chest tubes were removed in the second 24 hours after surgery. Demographics, lactate and pH at the beginning, during and after the operation, creatinine, left ventricular ejection fraction, inotropic drugs administration, length of ICU stay, and mortality data were collected. Respiratory rate and pain level was assessed. RESULTS: In these surgeries, the mean± standard deviation for the aortic clamping time was 49.18±17.59 minutes and cardiopulmonary bypass time was 78.39±25.12 minutes. The amount of heparin consumed by the second group was higher (P <0.001) which could be considered as an important factor in increasing the drainage time after the surgery (P =0.047). The pain level evaluated 24 hours post-operation was lower in the first group, and the difference in the pain level between the 2 groups evaluated 30 hours post-operation was significant (P=0.016). The mean time of intensive care unit stay was longer in the second group but it was not statistically significant. CONCLUSION: Early extracting of chest tubes after coronary artery bypass graft surgery when there is no significant drainage can lead to pain reduction and consuming oxygen is an effective measure after surgery toward healing; it doesn't increase the risk of creation of plural effusion and pericardial effusion.