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Interventional cardiology
Original research article
Premedication to reduce anxiety in patients undergoing coronary angiography and percutaneous coronary intervention
  1. Wieneke Vlastra1,
  2. Ronak Delewi1,
  3. Wim J Rohling1,
  4. Tineke C Wagenaar1,
  5. Alexander Hirsch1,
  6. Martin G Meesterman1,
  7. Marije M Vis1,
  8. Joanna J Wykrzykowska1,
  9. Karel T Koch1,
  10. Robbert J de Winter1,
  11. Jan Baan Jr1,
  12. Jan J Piek1,
  13. Mirjam A G Sprangers2 and
  14. José P S Henriques1
  1. 1 Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
  2. 2 Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Dr Wieneke Vlastra; w.vlastra{at}amc.uva.nl

Abstract

Aims In this study, we examined the effects of the routinely administration of benzodiazepines on reducing periprocedural anxiety versus no premedication.

Methods In this open label study, we enrolled 1683 patients undergoing diagnostic coronary angiograms (CAG) or percutaneous coronary interventions (PCI). Randomisation was simulated by systematically allocating patients in monthly rotational periods to lorazepam 1  mg/sl, oxazepam 10  mg/po, diazepam 5  mg/po, midazolam 7.5  mg/po or no premedication. Anxiety was measured at four different time points using the one-item Visual Analogue Scale for Anxiety (VAS score) ranging from 0 to 10. The primary outcome was the difference in anxiety reduction (ΔVAS, preprocedure to postprocedure), between the different premedication strategies versus no premedication.

Results Anxiety reduction was larger in patients premedicated with lorazepam (ΔVAS=−2.0, SE=1.6, P=0.007) or diazepam (ΔVAS=−2.0, SE=1.5, p=0.003) compared with patients without any premedication (ΔVAS=−1.4, SE=1.2). The use of midazolam or oxazepam did not lead to a significant reduction in anxiety compared with patients who did not receive premedication. Additionally, a high number of patients treated with midazolam (N=39, 19.8%) developed side effects.

Conclusions In this study, the use of lorazepam or diazepam was associated with a significant, but modest anxiety reduction in patients undergoing CAG or PCI. This study does not support the standard use of oxazepam or midazolam as premedication to reduce anxiety.

  • adjunctive pharmacotherapy
  • anxiety
  • percutaneous coronary interventions
  • coronary angiogram

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2018-000833

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    Footnotes

    • Contributors WV and RD were responsible for the writing of the current manuscript. WJR, TCW, AH, MGM, MMV, JJW, KTK, RJdW, JB, MAGS, JJP and JPSH all helped to collect data and provided valuable edits to the manuscript.

    • Funding This study was initiated and sponsored by the Heart Center of the Academic Medical Center.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Institutional Review Board of the Academic Medical Center (AMC).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data statement No additional data are available.