A randomized control clinical trial of brief supportive psychotherapy in acute coronary syndrome patients: focus on neutrophil-lymphocyte ratio and psychological symptoms

Abstract

Background Neutrophil-lymphocyte ratio (NLR) may predict prognosis in acute coronary syndrome (ACS) patients. Psychological conditions play a role before, during and after infarction that can be treated with brief supportive psychotherapy (BSP). This study aimed to analyze effect of BSP on NLR and psychological symptoms (PS) in ACS patients. Methods This double opened clinical randomized study included ACS patients who were treated in Intensive Cardiac Care Unit (ICCU) Cipto Mangunkusumo Hospital, Jakarta in April to July 2019. The BSP was planned for 5 sessions as long as the patients were in ICCU. NLR and PS that was evaluated using hospital anxiety depression scale were measured at baseline and after last BSP or right before discharged from ICCU. Data were analyzed with independent t-test or Mann-Whitney test. Results We recruited 32 patients in BSP and 35 patients in control group. The median age was 55 (32 – 86) years old and mostly were men (75%). The median length of stay in ICCU was 5 (2-13) days. NLR was similar in BSP and control group (3.35 [2.26] vs 3.63 [1.79], p=0.346). ΔNLR was higher in BSP than control group in patients without CHF (3.87 [5.48] vs 0.33 [2.54], p=0.007) and without CAD (3.88 [4.55] vs 0.84 [2.51], p=0.014). Meanwhile, Δ depression score was higher in BSP than control group in patients with CHF (1.73 [3.58] vs -1.27 [2.8], p=0.041) and with CAD (2.08 [3.4] vs -0.8 [3.3], p=0.035). Conclusions There was influence of BSP on NLR in ACS patients without CHF or CAD, and psychological symptoms in ACS ones with CHF or CAD. This trial had registered in ClinicalTrial.gov.id with code number NCT04274205.