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Abstract

Objective

This study aimed to evaluate the perceived stress and anxiety levels of patients undergoing coronary angiography and examine the impact of the procedure area on these psychological factors.

Methods

A total of 144 patients were included, and data were collected using the Personal Information Form, State–Trait Anxiety Scale, and Perceived Stress Scale. Statistical analyses were performed using IBM SPSS Statistics 23, along with independent sample t-tests, one-way analysis of variance, Levene’s test, post-hoc tests, Pearson correlation, and Cronbach’s alpha for reliability.

Results

The mean patient age was 54.31 ± 12.50 years; 63.2% of them were male. Overall, 58.3% of the patients underwent coronary angiography for diagnostic purposes, and 61.8% were aware of the procedure area. State anxiety, trait anxiety, and perceived stress scores were 46.78 ± 11.81, 41.35 ± 9.98, and 16.74 ± 5.32, respectively. Higher anxiety was observed among patients unaware of their diagnosis and those undergoing repeat coronary angiography. Patients who were undergoing femoral angiography had higher perceived stress than those undergoing angiography through the radial route.

Conclusion

Uncertainty about diagnosis and the procedure increases stress and anxiety. Providing preprocedural education during coronary angiography and exploring alternative anxiety management strategies, such as mindfulness, could enhance patient experience and recovery.

Keywords

Perceived stress nursing care anxiety level coronary angiography coronary artery disease

Introduction

The coronary arteries are the main vessels that supply the heart with blood. Because of the narrowing or blockage of these vessels, the heart cannot be adequately nourished and cannot fully fulfill its function. This condition is known as coronary artery disease (CAD).¹

CAD is the most important morbidity problem in developed societies. For example, it accounts for 42% of all deaths in the US adult population.² In Turkey, according to the “Heart Health and Risk Factors in Turkish Adults (TEKHARF)” study, 400,000–420,000 patients are newly diagnosed with CAD within 1 year, and 340,000 adults die within 1 year.³ Coronary angiography (CAG) is the most commonly used and reliable diagnostic test for CAD.⁴ According to the Turkish Society of Cardiology, CAG is the most accurate diagnostic method. In another study, CAG was clinically accepted as the gold standard for diagnosing CAD, which has an important place in terms of individual and public health.⁵

Stress negatively affects a person’s normal functions, and prolonged exposure to stress can also cause various health problems and even negatively affect a person’s functioning and quality of life.⁶ Perceived stress refers to the feelings and thoughts of an individual regarding how stressed they are at a certain time or in a certain situation. Perceived stress involves how much control a person has over their life, how they can cope with difficulties, and their self-confidence in this regard.⁷

Conversely, anxiety refers to a feeling of being overwhelmed with the fear of the unknown and the worry that something bad will happen. By definition, it refers to a feeling of distress and sadness. Anxiety can be categorized into mild, moderate, severe, and panic levels. Moreover, it is categorized as trait anxiety and state anxiety. State anxiety determines how individuals feel at a given moment; trait anxiety determines how individuals feel independent of the current situation.^8–11

Individuals undergoing CAG may experience anxiety due to the following reasons: (a) insufficient information about the procedure; (b) the fact that it is an interventional procedure; (c) the possibility of a new diagnosis that may be life-threatening; and (d) the risk of developing complications related to the procedure. In addition, the presence of pressurized dressing and sandbags in the intervention area may cause pain in this area.^3,12,13

Therefore, this study aimed to determine the perceived stress and anxiety levels of patients undergoing CAG, with the research question focusing on whether the procedure area and patient awareness of the diagnosis influence these psychological factors.

Methods

This study was designed as a prospective observational, cross-sectional single-center study. The reporting of this study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.¹⁴ The study protocol was approved by the Health Sciences University Derince Training and Research Hospital Clinical Research Ethics Committee (approval no: 2022-129). The study population consisted of patients admitted to the coronary intensive care units of Derince Training and Research Hospital between 1 December 2022 and 1 December 2023. The study sample consisted of 144 patients (91 men and 53 women) who consented to participate in the study and who met the research criteria (i.e. patients over 18 years of age and those who were fully oriented to person, place, and time and were willing to participate in the study). Patients signed an informed consent form before participating in the study. The questionnaires were administered to patients admitted to the coronary intensive care unit prior to undergoing CAG. Patients aged <18 years and those with incomplete data on orientation to person, place, and time were excluded from the study.

Study protocol

Personal Information Form, Perceived Stress Scale (PSS), and State–Trait Anxiety Scale were used by the researchers after reviewing the relevant literature.

Personal Information Form

The Personal Information Form was used to obtain information such as age, sex, education level, height/weight, marital status, duration of hospitalization, any chronic disease status, smoking/alcohol habits, history of CAG, and current knowledge of CAG.

PSS

PSS was developed by Cohen et al.¹⁵ in 1983, with a Cronbach’s alpha value of 0.86. It was adapted into Turkish by Bilge et al.¹⁶ in 2009, with a Cronbach’s alpha value of 0.81. The scale has two subscales: perceived stress (1st, 2nd, 3rd, 7th, and 8th items) and perceived coping (4th, 5th, and 6th items). The 1st, 2nd, 3rd, 7th, and 8th items are straight items, whereas the 4th, 5th, and 6th items are reverse items. The evaluation is conducted based on the total score and subscale score. Individuals are given five options to answer (0 (not at all) to 4 (very often)), and scores between 0 and 32 are obtained. If the total score is high, the perceived stress level is also high. High scores on the subscales indicate a negative situation. A total score of 0–32 is obtained from the scale. A high total score indicates a high perceived stress level. A high score in the subscales indicates a negative situation.¹⁵

State–Trait Anxiety Scale

State–Trait Anxiety Scale is an assessment scale developed by Spielberger et al.¹¹ to measure both dimensions of anxiety. The scale aims to assess state and trait anxiety separately. State anxiety determines how individuals feel at a given moment; trait anxiety determines how individuals feel independent of the current situation.¹⁶ The Turkish validity and reliability study was conducted by Oner and Compte,⁹ and Cronbach’s alpha coefficients were found to be 0.83–0.92 for the state anxiety scale and 0.86–0.92 for the trait anxiety scale. There are two separate scales for the two states in the scale. The STAI-I scale measures state anxiety, while the STAI-II scale measures trait anxiety. Each item in the scale is evaluated by individuals by providing scores between 1 and 4. Response options are categorized into four classes. In the state anxiety scale, the grades are as follows: not at all (1), a little (2), a lot (3), and completely (4). The options in the trait anxiety scale are as follows: almost never (1), sometimes (2), very often (3), and almost always (4). When scoring, responses with a value of 4 in direct statements indicate high anxiety, whereas responses with a value of 1 in reverse statements indicate high anxiety. There are 10 reversed statements in the state anxiety scale (items 1, 2, 5, 8, 10, 11, 15, 16, 19, and 20). The number of reversed statements in the trait anxiety scale (items 21, 26, 27, 30, 33, 36, and 39) is seven. During the evaluation, two keys are created for direct and reversed statements, and their total weights are found. From the total weighted score obtained for the direct statements, the total weighted score of the reversed statements is subtracted, after which 50 points for the state anxiety scale and 35 points for the trait anxiety scale are added to this number. These values are predetermined and unchangeable. The higher the sum of the scores, the higher the level of state and trait anxiety. The average score level determined in the applications is between 36 and 41.⁹

Ethical aspects of research

Ethics Committee Approval (No: 2022-129) was obtained from the Health Sciences University Derince Training and Research Hospital Clinical Research Ethics Committee, and institutional permissions were obtained from the hospital where the study was conducted.

Statistical analysis

Data analysis was performed using IBM SPSS Statistics 23 program. Frequency distribution (number, percentage) for categorical variables and descriptive statistics (mean, standard deviation, minimum, and maximum) for numerical variables were used to evaluate the data. The difference between the two groups was analyzed via independent sample t-test, and the difference between more than two groups was analyzed via one-way analysis of variance (ANOVA). Because of one-way ANOVA, Levene’s test was performed for homogeneity of variance, after which the group or groups from which the difference originated were checked by a multiple comparison test (Bonferroni or Tamhane’s T2). Bonferroni test was used to examine the difference between groups in variables that provided homogeneity of variance, and Tamhane’s T2 test was used to examine the difference between groups in variables that did not provide homogeneity of variance. Pearson correlation analysis was used to examine the relationship between the scales, and Cronbach alpha value was used for scale reliability.

Results

Participants’ demographic characteristics, health history characteristics, and characteristics of angiography status (N = 144)

Table 1 presents patient demographic, health, and angiography characteristics.

Table 1.

Participants’ health demographic characteristics, health history characteristics, and characteristics of angiography status (N = 144).

		n	%
Sex	Male	91	63.2
Sex	Female	53	36.8
Age	Mean ± SD (min–max)	54.31 ± 12.50 (19–85)
Education status	Illiterate	4	2.8
	Literate	10	6.9
	Primary school	37	25.7
	Middle school	31	21.5
	High school	40	27.8
	University and above	22	15.3
Income status	My income is less than my expenses	83	57.6
	My income is equal to my expenses	34	23.6
	My income is more than my expenses	27	18.8
People living together	With my wife	61	42.4
	Alone	15	10.4
	With children	13	9.0
	At home with my wife and children	52	36.1
	Other family members	3	2.1
Exercise	Yes	30	20.8
Exercise	No	114	79.2
Marital status	Married	114	79.2
Marital status	Single	30	20.8
Child status	No	13	9.0
	1	22	15.3
	2	39	27.1
	3	46	31.9
	4 and above	24	16.7
Employment status	Officer	18	12.5
	Worker	22	15.3
	Self-employment	20	13.9
	Housewife	33	22.9
	Retired	48	33.3
	Not working	3	2.1
Social security	Yes	133	92.4
Social security	No	11	7.6
Smoking status	Yes	66	45.8
Smoking status	No	78	54.2
Alcohol use status	Yes	23	16.0
Alcohol use status	No	121	84.0
Knowledge of the diagnosis	Yes	89	61.8
Knowledge of the diagnosis	No	44	30.6
	Not yet available	11	7.6
Diagnoses	Myocardial infarction	38	44.2
	Angina pectoris	34	39.5
	Heart spasm	7	8.1
	Heart failure	7	8.1
Other disease state	No	51	35.4
	HT	64	44.4
	DM	37	25.7
	Respiratory system disease	10	6.9
	Neurological problems	3	2.1
	Migraine	2	1.4
	Arrhythmia	1	0.7
	Hypothyroid	1	0.7
	Multiple sclerosis	1	0.7
Medication use status	Yes	93	64.6
	No	51	35.4
Number of medicines	None	51	35.4
	<5	81	56.3
	5–8	12	8.3
Family history of CAD	Yes	65	45.1
	No	79	54.9
Place of admission to hospital	Polyclinic	31	21.5
	Emergency service	113	78.5
Hospitalization for CAD	Yes	57	39.6
	No	87	60.4
Number of hospitalizations due to CAD	1	27	47.4
Number of hospitalizations due to CAD	2	18	31.6
	3 and more	12	21.1
History of CAG in the family	Yes	64	44.4
History of CAG in the family	No	80	55.6
Frequency of CAG	1	49	59.0
	2	22	26.5
	3 and more	12	14.5
Cause of CAG	Control	19	13.2
	Diagnosis	84	58.3
	Interventional	41	28.5
Previous angiography site	Groin	44	71.0
Previous angiography site	Arm	18	29.0
Knowledge of the area where angiography will be performed	Yes	89	61.8
Knowledge of the area where angiography will be performed	No	55	38.2
Angiography site	Groin	43	48.3
Angiography site	Arm	46	51.7
The site the patient wants to choose for angiography	Groin	27	18.8
The site the patient wants to choose for angiography	Arm	117	81.3
Status of receiving angiography information	Yes	108	75.0
Status of receiving angiography information	No	36	25.0
When he receives information	After being admitted to the ward	49	45.4
	When you are told that CAG will be performed	52	48.1
	On the way to CAG	7	6.5
Person informed about angiography	Nurse	5	4.6
	Physician	24	22.2
	Physicians and nurses	71	65.7
	Friends, neighbors, and relatives	8	7.4
What the patient wants to know about angiography	Preparations for coronary angiography	21	14.6
	Coronary angiography team and angiography environment	43	29.9
	How to perform coronary angiography	54	37.5
	Explanations before. during and after coronary angiography	72	50.0
Knowing the time of angiography	Yes	33	22.9
Knowing the time of angiography	No	111	77.1

HT: hypertension; DM: diabetes mellitus; CAD: coronary artery disease; CAG: coronary angiography.

Descriptive statistics of participants’ State–Trait Anxiety Scale scores and PSS and its subscale scores

The state anxiety scale score was 46.78 ± 11.81, the trait anxiety scale score was 41.35 ± 9.98, and the PSS score was 16.74 ± 5.32. The perceived stress subscale score was 11.24 + 4.08, and the perceived coping subscale score was 5.51 + 1.84. Participants had a moderate level of anxiety according to their mean scores. They were compatible with a moderate level of perceived stress and could not use effective stress management.

State–Trait Anxiety Scale scores as well as PSS and its subscale scores were higher in women than in men. Therefore, women had higher anxiety and worry. Trait anxiety scores were statistically significantly higher in patients with a lower education level than in those with higher education levels. The state anxiety scale score was higher in patients whose income was more than their expenses than in those whose income was less than their expenses. Individuals with better income had higher anxiety about angiography. The perceived coping subscale score was higher in patients living with their children than in patients living alone. Accordingly, patients living with their children tended to cope less with anxiety. The trait anxiety scale score was higher in nonworking individuals than in working individuals. In this case, nonworking individuals were more anxious than working individuals. The state anxiety scale score was higher in smokers than in nonsmokers, and the trait anxiety scale score was higher in nonsmokers than in smokers. According to these results, patients who smoked had higher state anxiety about angiography, whereas patients who consumed alcohol had lower anxiety levels than those who did not consume alcohol. There was a statistically significant difference in these results (p < 0.05; Table 2).

Table 2.

Examination of the relationship between the State–Trait Anxiety Scale, Perceived Stress Scale and its subscales, and demographic characteristics of the participants.

	State anxiety scale score	Trait anxiety scale score	Perceived stress scale score	Perceived stress subscale	Perceived coping subscale
	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD
Sex
Male	45.20 ± 11.32	38.54 ± 7.78	15.56 ± 5.15	10.46 ± 4.03	5.10 ± 1.65
Female	49.51 ± 12.23	46.19 ± 11.47	18.77 ± 5.02	12.57 ± 3.84	6.21 ± 1.94
t/p	−2.140/0.034*	−4.313/0.000*	−3.643/0.000*	−3.074/0.003*	−3.642/0.000*
Education status
Primary school and below	47.98 ± 11.82	44.35 ± 10.44^a	18.02 ± 5.04	12.04 ± 3.81	5.98 ± 1.92
Middle school	45.32 ± 10.54	40.90 ± 9.28	16.06 ± 5.01	10.84 ± 3.72	5.23 ± 1.78
High school	46.25 ± 12.49	39.45 ± 9.79	15.38 ± 5.93	10.10 ± 4.67	5.28 ± 1.69
University	47.05 ± 12.68	38.5 ± 8.95^b	17.23 ± 4.74	12.00 ± 3.66	5.23 ± 1.85
F/p	0.359/0.783	2.737/0.046*	2.140/0.098	2.097/0.103	1.785/0.153
Income status
My income is less than my expenses	46.66 ± 11.75^b	41.81 ± 10.83	17.25 ± 5.82	11.51 ± 4.34	5.75 ± 2.01
My income is equal to my expenses	42.26 ± 9.25^b	38.62 ± 7.77	15.26 ± 4.75	10.18 ± 3.88	5.09 ± 1.50
My income is more than my expenses	52.85 ± 12.57^a	43.41 ± 9.31	17.04 ± 4.04	11.74 ± 3.31	5.30 ± 1.56
F/p	6.529/0.002*	1.961/0.145	1.754/0.177	1.548/0.216	1.791/0.171
People living together
With my wife	46.82 ± 13.00	42.49 ± 10.51	17.00 ± 5.07	11.10 ± 3.97	5.90 ± 1.62
Alone	46.20 ± 12.21	37.93 ± 9.77	16.27 ± 5.31	11.47 ± 4.24	4.80 ± 1.70^b
With children	53.31 ± 8.09	46.46 ± 11.25	19.54 ± 4.79	13.38 ± 3.10	6.15 ± 1.99^a
At home with my wife and children	45.13 ± 10.95	39.88 ± 8.79	15.92 ± 5.74	10.81 ± 4.39	5.12 ± 2.00
F/p	1.670/0.176	2.399/0.071	1.688/0.172	1.421/0.239	3.093/0.029*
Exercise
Yes	45.70 ± 13.19	38.67 ± 7.66	15.77 ± 5.33	10.67 ± 4.23	5.10 ± 1.79
No	47.07 ± 11.46	42.06 ± 10.42	17.00 ± 5.31	11.39 ± 4.04	5.61 ± 1.84
t/p	−0.564/0.574	−1.991/0.051	−1.131/0.260	−0.859/0.392	−1.369/0.173
Marital status
Married	46.16 ± 12.10	41.61 ± 10.29	16.7 ± 5.51	11.11 ± 4.20	5.60 ± 1.90
Single	49.17 ± 10.46	40.40 ± 8.80	16.9 ± 4.59	11.73 ± 3.58	5.17 ± 1.56
t/p	−1.244/0.215	0.587/0.558	−0.201/0.841	−0.749/0.455	1.283/0.205
Child status
No	44.85 ± 11.30	36.00 ± 9.99	15.46 ± 6.19	10.77 ± 4.90	4.69 ± 1.84
1	47.18 ± 12.43	39.14 ± 10.99	16.91 ± 6.41	11.32 ± 4.91	5.59 ± 2.13
2	42.90 ± 11.83	41.31 ± 9.25	15.56 ± 4.83	10.15 ± 3.81	5.41 ± 1.53
3	49.24 ± 11.22	43.15 ± 10.7	17.85 ± 5.44	11.98 ± 4.15	5.87 ± 1.93
4 and above	49.08 ± 11.67	42.92 ± 7.83	17.08 ± 4.00	11.75 ± 2.77	5.33 ± 1.79
F/p	1.924/0.110	1.765/0.139	1.200/0.313	1.215/0.307	1.187/0.319
Employment status
Working	46.27 ± 12.08	38.27 ± 8.68	16.27 ± 5.62	11.08 ± 4.36	5.18 ± 1.88
Not working	47.15 ± 11.66	43.56 ± 10.31	17.08 ± 5.10	11.35 ± 3.89	5.74 ± 1.78
t/p	−0.444/0.658	−3.240/0.001*	−0.908/0.366	−0.379/0.705	−1.802/0.074
Social security
There is	46.50 ± 11.98	41.49 ± 10.21	16.63 ± 5.44	11.11 ± 4.11	5.53 ± 1.88
No	50.18 ± 9.31	39.73 ± 6.80	18.09 ± 3.42	12.82 ± 3.37	5.27 ± 1.19
t/p	−0.993/0.322	0.561/0.576	−1.287/0.218	−1.343/0.182	0.439/0.661
Smoking status
Yes	49.15 ± 12.31	39.95 ± 10.73	16.88 ± 6.12	11.38 ± 4.64	5.50 ± 1.96
No	44.78 ± 11.05	42.54 ± 9.21	16.63 ± 4.57	11.12 ± 3.56	5.51 ± 1.73
t/p	2.244/0.026*	−1.556/0.122	0.274/0.784	0.377/0.707	−0.042/0.967
Alcohol use status
Yes	47.78 ± 13.11	36.48 ± 7.82	15.70 ± 6.56	10.57 ± 5.07	5.13 ± 1.89
No	46.60 ± 11.59	42.28 ± 10.1	16.94 ± 5.06	11.36 ± 3.87	5.58 ± 1.82
t/p	0.441/0.660	−2.607/0.010*	−0.864/0.395	−0.716/0.480	−1.074/0.285

F: one-way analysis of variance; t: independent sample t-test; *: p < 0.05.

a, b: mean differences between groups (a: highest mean).

There was a statistically significant difference between the status of knowing the diagnosis and the reasons for CAG in terms of state anxiety scale score (p < 0.05). Accordingly, the state anxiety scale score was higher in patients who did not know the diagnosis than in those who did. In addition, the state anxiety scale score was higher in patients whose reason for CAG was control purposes than in those whose reason for CAG was interventional purposes. Accordingly, patients who did not know their diagnosis had higher anxiety about angiography. Patients who underwent angiography for control purposes had higher anxiety than those who underwent interventional angiography. There was no statistically significant difference between diagnoses, history of other diseases, medication use, number of medications used, history of CAD diagnosis in the family, place of admission, hospitalization due to CAD, number of hospitalizations due to CAD, history of CAD in the family, and number of CAD procedures in terms of all scale and subscale scores (p > 0.05). Accordingly, family history of CAD did not affect the level of anxiety and perceived stress (Table 3).

Table 3.

Examination of the relationship between the State–Trait Anxiety Scale, Perceived Stress Scale and its subscales, and health history characteristics of the participants.

	State anxiety scale score	Trait anxiety scale score	Perceived Stress Scale score	Perceived stress subscale	Perceived coping subscale
	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD
Knowledge of the diagnosis
Yes	44.80 ± 11.05^b	40.20 ± 8.67	16.52 ± 4.95	11.02 ± 3.89	5.49 ± 1.64
No	49.80 ± 12.21^a	43.80 ± 11.66	16.89 ± 6.09	11.43 ± 4.48	5.45 ± 2.18
Not yet available	50.82 ± 13.59	40.91 ± 11.80	18.00 ± 5.20	12.18 ± 4.05	5.82 ± 1.99
F/p	3.447/0.035*	1.946/0.147	0.400/0.671	0.465/0.629	0.176/0.839
Diagnoses
Myocardial infarction	45.55 ± 10.00	40.37 ± 7.71	17.39 ± 4.61	11.58 ± 3.63	5.82 ± 1.43
Angina pectoris	45.74 ± 12.32	40.79 ± 9.51	16.76 ± 4.68	10.94 ± 3.72	5.82 ± 1.55
Heart spasm	45.71 ± 6.87	43.29 ± 9.01	15.86 ± 7.84	10.57 ± 5.91	5.29 ± 2.21
Heart failure	37.00 ± 5.57	33.14 ± 8.01	13.71 ± 3.77	9.43 ± 2.57	4.29 ± 1.70
F/p	1.433/0.239	1.933/0.131	1.195/0.317	0.709/0.549	2.174/0.097
Other disease state
No	46.94 ± 11.76	39.24 ± 10.55	16.00 ± 5.66	10.76 ± 4.39	5.24 ± 1.78
Yes	46.70 ± 11.89	42.52 ± 9.51	17.15 ± 5.11	11.49 ± 3.90	5.66 ± 1.86
t/p	0.117/0.907	−1.904/0.059	−1.244/0.216	−1.027/0.306	−1.318/0.190
Medication use status
Yes	46.06 ± 11.93	42.12 ± 9.77	16.87 ± 5.48	11.29 ± 4.17	5.58 ± 1.94
No	48.10 ± 11.58	39.96 ± 10.31	16.51 ± 5.06	11.14 ± 3.93	5.37 ± 1.65
t/p	-0.988/0.325	1.243/0.216	0.389/0.698	0.215/0.830	0.649/0.517
Number of medicines
None	48.10 ± 11.58	39.96 ± 10.31	16.51 ± 5.06	11.14 ± 3.93	5.37 ± 1.65
<5	45.78 ± 12.00	42.06 ± 10.14	16.63 ± 5.57	11.16 ± 4.23	5.47 ± 1.98
5–8	48.00 ± 11.74	42.50 ± 7.05	18.50 ± 4.74	12.17 ± 3.83	6.33 ± 1.50
F/p	0.671/0.513	0.777/0.462	0.719/0.489	0.338/0.714	1.377/0.256
Family history of CAD
Yes	47.09 ± 10.48	42.25 ± 10.32	17.32 ± 4.96	11.65 ± 3.81	5.68 ± 1.72
No	46.53 ± 12.85	40.62 ± 9.70	16.27 ± 5.59	10.90 ± 4.28	5.37 ± 1.92
t/p	0.283/0.778	0.973/0.332	1.189/0.237	1.095/0.275	1.008/0.315
Place of admission to hospital
Polyclinic	45.52 ± 12.05	43.26 ± 11.44	17.26 ± 5.22	11.61 ± 3.90	5.65 ± 1.92
Emergency service	47.13 ± 11.77	40.83 ± 9.53	16.60 ± 5.36	11.13 ± 4.14	5.47 ± 1.82
t/p	0.674/0.501^a	1.201/0.232	0.607/0.545	0.579/0.563	0.472/0.638
Hospitalization for CAD
Yes	45.33 ± 11.81	41.25 ± 8.88	17.02 ± 5.02	11.67 ± 3.88	5.35 ± 1.89
No	47.74 ± 11.78	41.43 ± 10.69	16.56 ± 5.53	10.95 ± 4.20	5.61 ± 1.81
t/p	−1.196/0.234	−0.105/0.916	0.500/0.618	1.026/0.307	−0.825/0.411
Number of hospitalizations due to CAD
1	46.48 ± 12.10	42.63 ± 10.05	17.59 ± 4.77	12.33 ± 3.80	5.26 ± 1.89
2	43.06 ± 9.59	40.06 ± 8.22	16.06 ± 4.21	10.78 ± 3.30	5.28 ± 1.87
3 and more	46.17 ± 14.46	39.92 ± 7.03	17.17 ± 6.67	11.50 ± 4.83	5.67 ± 2.02
F/p	0.483/0.619	0.616/0.544	0.505/0.607	0.876/0.422	0.208/0.813
History of CAG in the family
Yes	46.98 ± 10.92	42.83 ± 10.18	17.36 ± 5.09	11.64 ± 3.83	5.72 ± 1.82
No	46.63 ± 12.54	40.18 ± 9.72	16.25 ± 5.48	10.91 ± 4.26	5.34 ± 1.84
t/p	0.181/0.857	1.594/0.113	1.246/0.215	1.065/0.289	1.241/0.217
Frequency of CAG
1	46.94 ± 11.92	43.45 ± 10.05	16.80 ± 5.26	11.31 ± 3.83	5.49 ± 1.89
2	43.45 ± 9.56	41.00 ± 8.58	16.86 ± 5.73	11.50 ± 4.51	5.36 ± 2.01
3 and more	44.42 ± 14.98	39.75 ± 5.77	16.58 ± 4.70	11.33 ± 3.45	5.25 ± 1.76
F/p	0.734/0.483	1.064/0.350	0.011/0.989	0.018/0.982	0.090/0.914
Cause of CAG
Control	51.53 ± 10.91^a	43.74 ± 11.35	17.79 ± 5.45	12.16 ± 4.10	5.63 ± 2.11
Diagnosis	47.24 ± 12.53	41.62 ± 9.85	16.75 ± 5.32	11.17 ± 4.12	5.58 ± 1.79
Interventional	43.66 ± 9.88^a	39.71 ± 9.54	16.24 ± 5.32	10.95 ± 4.01	5.29 ± 1.82
F/p	3.121/0.047*	1.131/0.326	0.545/0.581	0.594/0.553	0.392/0.676

F: one-way analysis of variance; t: independent sample t-test; *: p < 0.05

a, b: mean differences between groups (a: highest mean).

CAD: coronary artery disease; CAG: coronary angiography.

There was a statistically significant difference in the PSS and its subscale scores between the site of angiography and the site preferred for angiography (p < 0.05). Specifically, patients who underwent angiography through the femoral route exhibited higher PSS and its subscale scores than those who underwent angiography through the radial route. Similarly, patients who preferred the femoral route for angiography had higher PSS and its subscale scores than those who preferred the radial route. These results indicate that patients who underwent angiography through the femoral route as well as those who preferred the femoral site experienced higher levels of stress.

However, there was no statistically significant difference in PSS and its subscale scores or State–Trait Anxiety Scale scores between the region of previous angiography and the knowledge of the angiography site (p > 0.05).

A statistically significant difference (p < 0.05) was found in state anxiety scale scores based on the conditions of receiving information about the angiography procedure, the timing of receiving this information, and the source of information. Specifically, patients who did not receive information about the angiography procedure had higher state anxiety scores than those who did. Furthermore, patients who received information about the angiography while on their way to the procedure had higher anxiety scores than those who were informed earlier, before knowing how the exact procedure would take place. Additionally, patients who received information from friends, neighbors, or relatives had higher anxiety scores than those who received information from a physician.

These findings suggest that the anxiety levels of patients who were not informed or received late or less reliable information were higher. Moreover, there was a significant difference (p < 0.05) between patients who knew the time of their angiography and those who did not, with the latter group showing higher State–Trait Anxiety Scale scores. This indicates that the uncertainty regarding the timing of the angiography procedure contributes to increased anxiety (Table 4).

Table 4.

Examination of the relationship between the State–Trait Anxiety Scale, Perceived Stress Scale and its subscales, and participants' characteristics regarding angiography conditions.

	State anxiety scale score	Trait anxiety scale score	Perceived stress scale score	Perceived stress subscale	Perceived coping subscale
	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD
Previous angiography site
Groin	44.2 ± 11.54	41.14 ± 8.75	16.07 ± 4.78	10.70 ± 3.59	5.36 ± 1.78
Arm	47.50 ± 9.87	42.00 ± 8.96	17.33 ± 5.31	12.00 ± 4.37	5.33 ± 1.94
t/p	−1.061/0.293	−0.350/0.727	−0.916/0.363	−1.211/0.231	0.059/0.953
Aware of the area of angiography
Yes	47.29 ± 11.35	42.53 ± 9.34	17.33 ± 4.88	11.61 ± 3.61	5.72 ± 1.78
No	45.96 ± 12.57	39.45 ± 10.76	15.80 ± 5.88	10.64 ± 4.72	5.16 ± 1.88
t/p	0.655/0.514	1.810/0.072	1.683/0.095	1.308/0.194	1.777/0.078
Where to perform angiography?
Groin	48.88 ± 10.76	44.37 ± 9.67	18.51 ± 4.55	12.60 ± 3.10	5.91 ± 1.86
Arm	45.80 ± 11.80	40.80 ± 8.77	16.22 ± 4.97	10.67 ± 3.82	5.54 ± 1.71
t/p	1.284/0.203	1.825/0.071	2.266/0.026*	2.623/0.010*	0.960/0.340
Which site would you choose for angiography?
Groin	48.74 ± 11.75	42.56 ± 8.51	18.59 ± 4.90	12.78 ± 3.81	5.81 ± 1.82
Arm	46.33 ± 11.82	41.08 ± 10.3	16.32 ± 5.34	10.88 ± 4.07	5.44 ± 1.84
t/p	0.955/0.341	0.693/0.490	2.026/0.045*	2.209/0.029*	0.966/0.335
Status of receiving angiography information
Yes	45.47 ± 12.09	40.50 ± 9.73	16.49 ± 5.41	10.99 ± 4.20	5.50 ± 1.89
No	50.72 ± 10.06	43.92 ± 10.43	17.50 ± 5.03	11.97 ± 3.65	5.53 ± 1.68
t/p	−2.572/0.012*	−1.793/0.075	−0.986/0.326	−1.253/0.212	−0.078/0.938
Time of receipt of information
After being admitted to the ward	47.49 ± 12.21	41.04 ± 9.70	16.82 ± 5.49	11.22 ± 4.13	5.59 ± 2.04
When you are told that CAG will be performed	42.23 ± 10.60^b	39.10 ± 9.77	15.92 ± 5.51	10.54 ± 4.34	5.38 ± 1.82
On the way to CAG	55.43 ± 14.85^a	47.14 ± 7.20	18.43 ± 3.95	12.71 ± 3.45	5.71 ± 1.50
F/p	5.321/0.006*	2.305/0.105	0.821/0.443	0.967/0.383	0.196/0.822
The person from whom you would receive information about angiography
Nurse	49.20 ± 12.91	42.20 ± 11.08	16.80 ± 3.11	10.60 ± 2.51	6.20 ± 1.30
Physician	40.21 ± 9.73^b	36.21 ± 7.52	15.96 ± 5.36	11.13 ± 4.03	4.83 ± 1.88
Physicians and nurses	45.93 ± 12.36	41.24 ± 10.22	16.31 ± 5.65	10.75 ± 4.42	5.56 ± 1.95
Friends, neighbors, and relatives	54.88 ± 9.69^a	45.75 ± 6.54	19.50 ± 4.07	13.00 ± 3.46	6.50 ± 0.93
F/p	3.559/0.017*	2.638/0.053	0.932/0.428	0.708/0.549	2.052/0.111
Aware of the time of angiography
Yes	43.42 ± 9.66	38.24 ± 7.69	15.55 ± 4.67	10.42 ± 3.80	5.12 ± 1.80
No	47.78 ± 12.23	42.28 ± 10.42	17.10 ± 5.47	11.48 ± 4.14	5.62 ± 1.84
t/p	−2.133/0.037*	−2.063/0.041*	−1.479/0.141	−1.306/0.194	−1.379/0.170

F: one-way analysis of variance; t: independent sample t-test; *: p < 0.05.

a, b: mean differences between groups (a: highest mean).

CAG: coronary angiography.

There is a statistically significant positive correlation between State–Trait Anxiety Scale scores and PSS and its subscale scores (p < 0.05). In this context, if state and trait anxiety increases, perceived stress also increases (Table 5).

Table 5.

Examination of the relationship between the State–Trait Anxiety Scale and Perceived Stress Scale and its subscales.

		Perceived stress scale score	Perceived stress subscale	Perceived coping subscale
State anxiety scale score	r	0.597	0.584	0.434
	p	0.000*	0.000*	0.000*
	N	144	144	144
Trait anxiety scale score	r	0.687	0.616	0.622
	p	0.000*	0.000*	0.000*
	N	144	144	144

r: Pearson correlation coefficient; *: p < 0.05.

Discussion

Our study found that patients who underwent CAG through the femoral route experienced significantly higher perceived stress levels than those who underwent the procedure via the radial route. Additionally, patients who were not informed about the procedure experienced higher anxiety levels, especially those who received information at the time of angiography or from nonmedical sources. We also observed that smoking was associated with higher anxiety levels, and patients who were unaware of the time of their angiography had elevated anxiety levels.

CAG enables the identification and simultaneous treatment of CADs. Therefore, it has become a frequently used method worldwide, and the number of studies on this subject is increasing.^5,17

It has been reported that men are more likely to develop CAD than women, but the prognosis is worse and morbidity is higher in women.^18,19 In this study, the majority (63.2%) of the patients undergoing CAG were male. However, in the study conducted by Özdemir et al.,²⁰ the majority of patients were female. When the literature was examined, it was concluded that the number of male individuals was higher in most studies similar to this study.^3,21–24

In this study, anxiety levels and anxiety scores in all scales were found to be higher in women than in men. In the study of Yel and Ünsar,³ the trait anxiety score of women and the anxiety score of women in the study of Atik et al.²⁴ were found to be higher compared with men. These results are in parallel with the study. In contrast to these findings, there are studies in which men’s state–trait anxiety scores were found to be higher than women’s.^5,25 It is thought that the reason for the higher anxiety and anxiety levels of women in the study may be that women have a more sensitive structure, have a greater sense of responsibility, and think in more detail.

In this study, which aimed to determine the anxiety status and anxiety level of the patients before angiography, the State–Trait Anxiety Scale scores were found to be moderate, and the PSS score was also found to be moderate. Although these results are close to the results of other studies, differences are likely to occur due to factors such as patient profile and sample size.^3,26,27

In this study, the trait anxiety score was found to be higher in the group with an educational level of primary school and below than in the group with an educational level of university and above. In studies investigating the effect of education level on anxiety level before CAG in the literature, Ali²³ found that anxiety levels decreased as the education level increased, consistent with the finding of Yel and Ünsar.³ It is believed that this result is related to knowing the methods of coping with stress through increasing education level and health literacy, performing good disease management, enhancing adherence to treatment, and making conscious decisions in lifestyle planning.

When the anxiety levels of the patients were examined according to their income status, it was found that the state anxiety score was higher in those whose income status was higher than the expense status. In the study by Bural Aydın,²⁸ the state anxiety of patients whose income was equal to their expenses was found to be lower than that of patients whose income was less than their expenses. The disease, the process of hospitalization and surgery, and the fear of the unknown caused by this process increase both the information and counseling needs of patients. Although this is especially important for patients with low levels of education and income, patients with high levels of education and good income can also experience the same anxiety and fear.

In our study, when cohabitants and anxiety were analyzed, it was found that people living with their children were less capable of coping with anxiety than people living alone. It was believed that although children provide life support to individuals, these individuals could not cope with anxiety due to the sense of responsibility felt toward them. In the study conducted by Karabiber and Dığın,²⁹ no significant association was found between cohabitants and anxiety. These distinct results may be related to sample diversity across studies.

In this study, the trait anxiety scale score of patients who were not working was higher than that of working patients, whereas in the study conducted by Atik et al.,²⁴ the anxiety score was higher in working patients. Accordingly, the trait anxiety scale score of patients who were not working was higher; this may be due to the lack of social support received away from their working life or their financial needs.

When the relationship between smoking and CAG was analyzed in terms of anxiety level, it was found that the state anxiety score was higher in smokers than in nonsmokers. Similarly, in the literature, it was found that the anxiety score of smokers was higher than that of nonsmokers.³⁰ Smoking, which is a risk factor for CAD,^31,32 also causes stress. Moreover, we can attribute the high anxiety of smokers about angiography to the fact that patients are aware that smoking negatively affects their health and therefore feel anxiety.

When the relationship between alcohol use and CAG was examined in terms of anxiety level, it was found that the level of trait anxiety was higher in nonalcohol users than in alcohol users. In this case, the anxiety level of alcohol users was lower than that of nonalcohol users. The reason for the low level of anxiety in alcohol users may be related to the demographic and personality characteristics of the patients.

Most of the participants in the study were aware of their diagnosis, but those who did not know about their diagnosis had higher state anxiety scale scores than those who did. Unawareness of their diagnosis, fear of the unknown, and having no idea about the angiography procedure may have contributed to this result by causing tension.

When the site of angiography and anxiety status were examined, it was found that patients who underwent angiography through the femoral route had higher scores on PSS and its subscales than those who underwent angiography through the radial route. In the study by Çiraci³³ investigating the comfort levels of patients who underwent angiography through the radial and femoral routes, it was found that the comfort level of those who underwent angiography through the radial route was higher than that of patients who underwent angiography through the femoral route, and the relaxation and spaciousness scores were also higher in those who underwent angiography through the radial route. Based on this, it was believed that increasing the comfort level of the patients would contribute to a decrease in anxiety. In addition, when the literature was examined, it was found that angiography through the femoral route is frequently performed; however, after the procedure, sandbags should be placed for compression, patients should be lying flat for a long time, and occurrence of too much lying flat on the bed should be low; prolonged bed rest may cause back pain, procedure site pain, and leg pain. Pain and anxiety are interactive sources of stress.²⁴ In the study conducted by Cihan,³⁴ the comfort level of patients who underwent angiography through the radial route and patients with shorter bed rest were found to have a higher comfort level. This explains the higher anxiety of patients who underwent angiography through the femoral route.

In the study, patients who preferred the femoral region as the site of angiography had higher PSS and subscale scores than those who preferred the radial region. It is known that manual and sandbag compression is very common in the literature, but this practice greatly impairs patient comfort.³⁵ For this reason, it can be said that the PSS and its subgroups are high in patients whose angiography preference is femoral. Conversely, it can be said that the reason why these patients do not prefer the radial route is that the pain sensation is felt more in this region, because the radial vessel diameters are smaller and superficial.

In the study conducted by Fındık and Yıldızeli Topçu,³⁶ it was observed that the information given before surgery reduced anxiety. In the literature, there are studies showing that the anxiety level of people who did not receive information about CAG was higher than those who did.^21,23 In our study, the results parallel to this information were obtained. According to the results, it was determined that the state anxiety scale score of people who did not receive information about CAG was higher than those who received information. This result shows that patients who were not informed were more anxious. When individuals think that there will be a procedure related to the heart, which is a very important organ for life, and when this is accompanied by the fear of death, their anxiety may be high. Increased anxiety can negatively affect the cardiovascular system. Patients are confused by misinformation and bad experiences heard from others. Not knowing how the procedure will be performed, where it will be performed and the environment causes fear. For all these reasons, patients should be given timely and complete information about the procedure.

In the study, when the patients were informed also affected the level of anxiety; the state anxiety scale score of those who received information on the way to angiography was higher than those who received information when they were told that angiography would be performed. In the study by Gören,²⁵ the state–trait scale score of those who received information after being admitted to the ward was higher than those who received information when they were told that angiography would be performed. As the information given to patients reduces anxiety, the time of giving information is also important for the patient to prepare himself/herself for the process. It is thought that timely information for patients to feel physically and emotionally ready will reduce the level of anxiety.

The anxiety level in patients who did not know what time they would be admitted to angiography was found to be higher than those who knew. In parallel with this in Gören²⁵ study, the state–trait anxiety score of patients who knew the procedure time was found to be lower than those who did not know. It was observed that fear of the unknown increased anxiety in patients. In addition, studies have found that patients experience significant anxiety before angiography and that having angiography increases fear and anxiety.^27,36,37 It is known that the anxiety experienced by patients before CAG also causes hemodynamic changes.³⁸ In this case, patient’s knowledge of the time of angiography was found to be an important factor affecting the level of anxiety, and it was seen that informing the patient before angiography is important.

In the study conducted by Cihan,³⁴ it was found that the comfort level of people who received information from the physician was higher, and it was determined that patients felt better when they received information from the physician. Among people who received information in the study, those who received information from friends, neighbors, and relatives had higher state anxiety scale scores than those who received information from physicians. The reason for this may be interpreted as not providing objective information, giving wrong information, or having bad experiences. In addition, the fact that nurses spend less time giving information creates the perception that they have less information on patients. Therefore, nurses, who have the closest communication with patients, should provide information to create a bond of trust and complete the lack of information of patients.

This study provides valuable insights into the psychological well-being of patients undergoing CAG, highlighting the influence of both the procedural approach (femoral vs. radial) and the timing of information delivery on anxiety levels. The findings emphasize the practical importance of early and accurate patient education, which appears to play a significant role in reducing preprocedural anxiety. This underlines the need for healthcare professionals to integrate psychological considerations into patient care and adopt communication strategies that foster trust and emotional preparedness before medical procedures.

Nevertheless, this study had limitations. The relatively small sample size may limit the generalizability of the findings to a broader patient population. Expanding the sample and including a more diverse demographic would strengthen the conclusions and enhance their applicability across different patient groups. Additionally, the cross-sectional design restricts the ability to establish causal relationships between the studied variables. Future longitudinal research would be particularly useful in examining the long-term effects of anxiety reduction on patient recovery and procedural outcomes. Another limitation is the reliance on self-reported data to assess anxiety, which can introduce subjective bias or inaccuracies. Incorporating objective measurements or physiological markers in future studies could provide a more comprehensive and reliable assessment of patient anxiety.

Although this study sheds light on the underexplored psychological dimensions of CAG, it also underscores the need for further research involving larger samples, longitudinal approaches, and multimethod anxiety assessments. Such research would not only deepen the understanding of patient experiences but also guide the development of effective educational and clinical practices aimed at reducing anxiety and improving patient care outcomes.

Recommendations for future research and clinical practice

Although this study provided valuable information, further research is needed to explore the long-term effects of preprocedural anxiety reduction on recovery and overall health outcomes. Additionally, developing standardized educational interventions tailored to individual patient needs could further improve anxiety management. Clinical guidelines should incorporate these findings to enhance preprocedural patient care and address the psychological aspects of undergoing CAG.

Conclusion

Based on the results, it is evident that the site of angiography (femoral vs. radial) significantly impacts perceived stress levels, with patients undergoing angiography through the femoral route experiencing higher levels of anxiety. Moreover, the timing and source of information provided to patients play a critical role in alleviating anxiety, with patients who were informed earlier and by healthcare professionals demonstrating lower anxiety scores.

The findings also underscore the importance of providing timely and accurate information to patients regarding their procedure as well as addressing factors such as smoking and alcohol use that may contribute to elevated anxiety levels. This study’s results provide valuable insights into patient care and highlight areas for further research, particularly in refining preprocedural education strategies and investigating the long-term effects of anxiety reduction on postprocedural outcomes.

Footnotes

Acknowledgements

We extend our sincere gratitude to all the patients who participated in this study.

Author contributions

Conception: AK and HCA

Design: AK and HCA

Supervision: HCA

Resource: AK and HCA

Materials: AK and HCA

Data collection and/or processing: AK and HCA

Analysis and/or interpretation: AK and HCA

Literature review: AK and HCA

Writing: AK and HCA

Critical review: HCA

Data availability statement

All data generated or analyzed during this study are included in this published article. Further inquiries may be directed to the corresponding author.

Declaration of conflicting interest

The authors declare that there are no conflicts of interest.

Funding

None.

ORCID iD

Hande Cengiz Açıl

References

Koplay

Erol

Coronary artery disease. Turk Radiol Semin 2013; 1: 57–69.

Virani

Alonso

Benjamin

; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommitteeet al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020; 141: e139–e596.

Yel

Unsar

Quality of life and anxiety levels of patients to undergo coronary angiography. J Cardiovasc Nurs 2020; 11: 7–15.

Nikfarjam

Firouzkouhi

Shahdadi

, et al. Comparison of the effectiveness of nursing consultation and guided imagery-based training on stress and anxiety in angiography candidates: a clinical trial. J Med-Surg Nurs 2020; 9: e111967.

Türker

Bedük

Determination of anxiety levels of coronary angiography patients and their spouses. Eurasian JHS 2021; 4: 80–90.

Tagay

Çalışandemir

Ünüvar

The relationship between young adults' perceived stress levels and irrational beliefs and self-esteem. Int J Educ Technol Sci Res 2018; 7: 167–175.

Phillips

AC.

Perceived stress. In: Gellman

Turner

(eds). Encyclopedia of behavioral medicine. New York: Springer, 2013.

Kaya

MN.

Determination of the effect of training given to patients who will have angiography on anxiety. Master’s Thesis, Mradialara University Institute of Health Sciences, Department of Nursing, Turkey, 2019.

Oner

N, L

Compte

State-trait anxiety inventory handbook. 20th ed. Istanbul: Boğaziçi University Publications, 1985, pp. 3–5.

10.

Yıldız

Yeniçeri

Öngel

Application of state-trait anxiety scale (STAI-TX) in randomly selected individuals and results. Smyrna Tıp Derg 2019; 1: 19–24.

11.

Spielberger

Gorsuch

Luschene

RE.

Manual for the state-trait anxiety inventory. California: Consulting Psychologists Press, 1970.

12.

Vizeli

The effect of music therapy on anxiety level in patients undergoing coronary angiography. Master’s Thesis, Haliç University Institute of Health Sciences, Department of Nursing, Turkey, 2010.

13.

Arıcı

Turan Kavradım

Comfort in cardiovascular diseases. Akd Hemşirelik 2023; 2: 32–39.

14.

Von Elm

Altman

Egger

, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573–577.

15.

Cohen

Kamarck

Mermelstein

A global measure of perceived stress. J Health Soc Behav 1983; 24: 385–396.

16.

Bilge

Öğce

Genç

, et al. Psychometric suitability of the Turkish version of the Perceived Stress Scale (PSS). Journal of Ege University School of Nursing 2009; 2: 61–72.

17.

Pamuk Cebeci

Veremci

Ş.

The evaluation of nursing care interventions for patients whom were planned to receive a coronary angiography. Eurasian JHS 2022; 5: 45–53.

18.

Gaine

Sharma

Tower-Rader

, et al. Multimodality imaging in the detection of ischemic heart disease in women. J Cardiovasc Dev Dis 2022; 9: 350.

19.

Jariwala

Jadhav

Dual left anterior descending artery: case series based on novel classification and its therapeutic implications. Indian Heart J 2022; 74: 218–228.

20.

Özdemir

Selvi

Boysan

, et al. Relationships between coronary angiography, mood, anxiety and insomnia. Psychiatry Res 2015; 228: 355–362.

21.

Balcı

Enç

The effect of audio-visual education given to coronary angiography patients over physiological and psychosocial parameters. Turk J Card Nur 2013; 4: 41–50.

22.

Yildirim

Coronary artery disease and nursing care. In: Güler

(ed). Health & science 2022 nursing-1. 1st ed. Istanbul: Efe Academy Publishing, 2022, pp. 31–44.

23.

Ali

SA.

Determination of the level of anxiety among patients scheduled for diagnostic cardiac catheterization. Journal of Babylon University 2015; 23: 891–898.

24.

Atik

Karatepe

, et al. The effect on anxiety level of coronary angiographic result and the perception of pain. Int J Res Med Sci 2015; 3: 391–398.

25.

Gören

EN.

Anxiety levels of patients before coronary angiography and determination of affecting factors. Master’s Thesis, Near East University Institute of Health Sciences, Nursing Graduate Program, Cyprus, 2019.

26.

Karaman Özlü

Özlü

Bağdigen

, et al. Determination of the effect of privacy on anxiety in patients undergoing coronary angiography and elective percutaneous coronary intervention: cross-sectional research. Turkiye Klinikleri J Health Sci 2022; 7: 465–472.

27.

Yılmaz

Sayın

Tel

Preprocedure information requirements and anxiety levels of patients to undergo coronary angiography. Turk Klin J Nurs Sci 2012; 4: 55.

28.

Bural Aydın

Evaluation of pre-procedure and post-procedure anxiety status in patients undergoing coronary angiography. Master’s Thesis, Eurasia University Graduate Education Institute, Department of Nursing, Turkey, 2023.

29.

Karabiber

Dığın

Anxiety and depression levels of patients who will have coronary artery bypass graft surgery and investigation of affecting factors. Gevher Nesibe J Med Health Sci 2023; 8: 1070–1078.

30.

Polat

Determination of the effect of information before coronary angiography on anxiety of patients. Master’s Thesis, Okan University Institute of Health Sciences, Department of Nursing, Turkey, 2018.

31.

Wang

, et al. Analysis of coronary artery lesion degree and related risk factors in patients with coronary heart disease based on computer-aided diagnosis of coronary angiography. Comput Math Methods Med 2021; 2021: 2370496.

32.

Omidi

Sadeghian

Salarifar

, et al. Relationship between the severity of coronary artery disease and cardiovascular risk factors in acute coronary syndrome: based on Tehran Heart Center's data registry. J Tehran Univ Heart Cent 2020; 15: 165–170.

33.

Ciraci

Determining the comfort levels of patients in radial and femoral access angiographies. Master’s Thesis, Medipol University Institute of Health Sciences, Department of Nursing, Turkey, 2019.

34.

Cihan

Evaluation of factors affecting immobilization comfort, hematoma and pain in patients undergoing coronary angiography. Master’s Thesis, Hasan Kalyoncu University Graduate Education Institute, Turkey, 2021.

35.

Beşli

Alişir

Keçebaş

, et al. [Comparison of pneumatic compression device and sand bag with respect to peripheral vascular complications in elective cardiac catheterization and percutaneous femoral artery interventions]. Turk Kardiyol Dern Ars 2013; 41: 478–485.

36.

Fındık

Topçu

The effect of the way of surgical intervention on the level of preoperative anxiety. Journal of Hacettepe University Faculty of Nursing 2015; 19: 22–33.

37.

Delewi

Rohlin

Wagenaar

, et al. Anxiety levels of patients undergoing coronary procedures in the catheterization laboratory. Int J Cardiol 2017; 228: 926–930.

38.

Nekouei

Yousefy

Manshaee

, et al. Comparing anxiety in cardiac patients candidate for angiography with normal population. Arya Atheroscler 2011; 7: 93–96.

Perceived stress and anxiety levels of patients undergoing coronary angiography

Abstract

Objective

Methods

Results

Conclusion

Keywords

Introduction

Methods

Study protocol

Personal Information Form

PSS

State–Trait Anxiety Scale

Ethical aspects of research

Statistical analysis

Results

Participants’ demographic characteristics, health history characteristics, and characteristics of angiography status (N = 144)

Descriptive statistics of participants’ State–Trait Anxiety Scale scores and PSS and its subscale scores

Discussion

Recommendations for future research and clinical practice

Conclusion

Footnotes

Acknowledgements

Author contributions

Data availability statement

Declaration of conflicting interest

Funding

ORCID iD

References