Please cite this article in press as: Tully PJ, et al. Cardiovascular risk profile before coronary artery bypass graft surgery in relation to depression and anxiety disorders: An age and sex propensity matched study. Aust Crit Care (2014), http://dx.doi.org/10.1016/j.aucc.2014.04.006 ARTICLE IN PRESS G Model AUCC-241; No. of Pages 7 Australian Critical Care xxx (2014) xxx–xxx Contents lists available at ScienceDirect Australian Critical Care j ourna l h o mepage: www.elsevier.com/locate/aucc Cardiovascular risk profile before coronary artery bypass graft surgery in relation to depression and anxiety disorders: An age and sex propensity matched study Phillip J. Tully a,b,∗ , Richard F. Newland a , Robert A. Baker a a Cardiac Surgery Research, Department of Surgery, Flinders Medical Centre, South Australia, Australia b Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia a r t i c l e i n f o r m a t i o n Article history: Received 17 October 2013 Received in revised form 8 January 2014 Accepted 22 April 2014 Available online xxx Keywords: Depressive disorder Anxiety disorders Coronary artery bypass Cardiopulmonary bypass a b s t r a c t Objective: The cardiovascular risk profile and postoperative morbidity outcomes of anxiety disorder patients undergoing coronary artery bypass surgery is not known. Methods: In a cross-sectional design, 114 consecutive coronary artery bypass graft surgery patients were evaluated to create four matched groups (30 with anxiety disorder, 27 with depression disorder and 57 age-sex matched coronary artery bypass surgery control patients with no depression or anxiety disorder). Results: By comparison to non-depression disorder age-sex matched controls, depressed patients pre- sented for coronary artery bypass surgery with significantly greater myocardial inflammatory markers (Troponin T > 02, 33.3% vs. 11.1%, p = .03), metabolic risk (body surface area > 35 (22.2% vs. 0%, p = .03), comorbid cardiovascular risk (peripheral vascular disease 18.5% vs. 0%, p = .05). Depressed patients also recorded longer intraoperative time at higher temperatures >37 ◦ C on cardiopulmonary bypass (11.1 ± 9.0 vs. 6.0 ± 4.9, p < 005) and had higher maximum postoperative Troponin T (.44 ± .2 vs. .28 ± .1, p = .03). Patients with anxiety disorder on the other hand presented with significantly higher Creatinine Kinase-Muscle Brain (5 IQR 4–5 ng/ml vs. 4 IQR 3–4 ng/ml, p = .04), higher intraoperative glucose levels (7.8 ± 2.5 mmol/l vs. 7.0 ± 1.2 mmol/l, p = .05), and received fewer grafts (2.1 ± .9 vs. 2.5 ± .9 p = .04). Conclusions: A differential cardiovascular risk profile and postoperative outcome was observed dependent on anxiety and depression disorder status. There were few modifiable cardiovascular risk factors at the time of surgery other than psychiatric status, perioperative management of depression and anxiety may have promise to reduce further cardiac morbidity after coronary artery bypass surgery. Crown Copyright © 2014 Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd) on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved. 1. Introduction A prognostic association between psychological depression and postoperative morbidity after coronary artery bypass graft (CABG) surgery has been previously documented. 1–5 The suspected mech- anisms through which depression leads to cardiopathogenesis have been comprehensively reviewed 6 and include dysreg- ulation of the hypothalamic–pituitary–adrenal axis, reduced ∗ Corresponding author at: Discipline of Medicine, The University of Adelaide, SA 5005, Australia. Tel.: +61 8 8404 2015; fax: +61 8 8404 2019. E-mail addresses: phillip.tully@adelaide.edu.au, drphil.81@gmail.com (P.J. Tully). heart-rate-variability, altered serotonergic pathways, inflamma- tory response and altered platelet aggregability, and dysrhythmia. The pathophysiological processes in depression may be particu- larly relevant to cardiac surgery and critical care settings because they are also known to be substantially influenced by the use of cardiopulmonary bypass (CPB). 2 However, despite recognition of depression posing a risk for further CHD morbidity, 1–3,7 there are few systematic investigations of the pathophysiological processes and risk factors faced by cardiac surgery patients with a psychi- atric disorder. 8 Therefore the potential implications for surgical, anaesthetic, perfusion and intensive care unit practices remain relatively unknown. There is a paucity of research that has examined the psychi- atric disorders interrelated with depression, namely anxiety, with http://dx.doi.org/10.1016/j.aucc.2014.04.006 1036-7314/Crown Copyright © 2014 Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd) on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved.