Assessing risk for major depression on patients selected for percutaneous transluminal coronary angioplasty: is it a worthwhile venture?

We hypothesized that a prior history of a major depressive disorder would not compromise the efficacy of percutaneous transluminal coronary angioplasty (PTCA), a coronary revascularization procedure, in improving quality of life and health status when comparing patients with no previous history. To determine the utility of screening for risk for depression in heart patients scheduled for PTCA, 190 patients were administered a two-item depressive disorders screener prior to PTCA and the SF-36 and Seattle Angina Questionnaire prior to and 6 months post procedure. Results reveal that while those with no prior history of depression had statistically better quality of life and health status outcomes than those with a probable past depression, (P <.05), the clinically meaningful differences as determined by effect size scores showed that those susceptible to recurrent depression benefited from PTCA as well as, and on some measures better than those with no previous history. Prescreening patients at probable risk for a depression is not a valid or helpful enterprise if the purpose is to develop intervention strategies for improving outcome post PTCA. Screening out patients based on history of depression may in fact lead to an inequitable allocation of resources and have no major benefit in enhancing quality of life and improving health status.

Stenting for coronary artery spasm.

We evaluated coronary stenting in nine patients with clinically severe, angiographically documented spasm refractory to aggressive pharmacologic management. No patient subsequently developed unstable ischemia requiring hospitalization as a consequence of recurrent spasm within the stent. Mechanisms of therapeutic failure included both persistent spasm and spasm in a different artery in one patient. Restenosis occurred in three patients who subsequently underwent repeat revascularization. In the rare, carefully selected patient, stents may represent an adjunct in the management of focal coronary artery spasm, although currently medical therapy remains the standard initial approach.