Effects of antidepressant medication of morbidity and mortality in depressed patients after myocardial infarction
Effects of antidepressant medication of morbidity and mortality in depressed patients after myocardial infarction
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DOI：
10.1001/archpsyc.62.7.792
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发表时间：
2005-07-01
影响因子：
--
通讯作者：
Jaffe, AS
中科院分区：
文献类型：
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作者：
Taylor, CB;Youngblood, ME;Jaffe, AS
背景：心肌梗死（MI）后抑郁与较高的发病率和死亡率相关。虽然抗抑郁药在减轻抑郁症方面是有效的，但它们在心血管疾病患者中的应用仍然存在争议。目的：对参加冠心病增强康复研究的心肌梗死后患者进行二次分析，以确定使用抗抑郁药物对其发病率和死亡率的影响。设计：观察性二次分析。设置：8个学术站点。患者：1996年10月1日至1999年10月31日，冠心病临床试验随机选取2481名抑郁症和/或社会隔离患者。通过结构化的临床访谈来诊断抑郁症。这项分析是在1834名抑郁症患者中进行的（849名女性和985名男性）。干预措施：使用抗抑郁药物。主要结局指标：无事件生存率定义为无死亡或复发性心肌梗死。全因死亡率也被检查。为了将抗抑郁药物暴露与随后的发病率和死亡率联系起来，使用时间相关协变量模型对数据进行了分析。在平均29个月的随访期间，发生了457例致死性和非致死性心血管事件。与不使用选择性5 -羟色胺再摄取抑制剂的患者相比，服用选择性5 -羟色胺再摄取抑制剂的患者死亡或心肌梗死复发的风险显著降低（校正危险比[HR]， 0.57； 95%可信区间[CI]， 0.38-0.84），全因死亡率（校正危险比[HR]， 0.59; 95% CI, 0.37-0.96）和心肌梗死复发的风险（校正危险比，0.53;95% Cl, 0.32-0.90）也是如此。对于服用非选择性5 -羟色胺再摄取抑制剂抗抑郁药的患者，与不服用的患者相比，死亡或复发性心肌梗死、全因死亡率或复发性心肌梗死风险的可比hr （95% CIS）分别为0.72（0.44-1.18）、0.64（0.34-1.22）和0.73（0.38-1.38）。结论：在经历急性心肌梗死的抑郁症患者中使用选择性血清素再摄取抑制剂可能会降低随后的心血管发病率和死亡率。需要一项对照试验来检验这一重要问题。
Background: Depression after myocardial infarction (MI) is associated with higher morbidity and mortality. Although antidepressants are effective in reducing depression, their use in patients with cardiovascular disease remains controversial.Objective: To undertake a secondary analysis to determine the effects of using antidepressants on morbidity and mortality in post-MI patients who participated in the Enhancing Recovery in Coronary Heart Disease study.Design: Observational secondary analysis.Setting: Eight academic sites.Patients: The Enhancing Recovery in Coronary Heart Disease clinical trial randomized 2481 depressed and/or socially isolated patients from October 1, 1996, to October 31, 1999. Depression was diagnosed using a structured clinical interview. This analysis was conducted on the 1834 patients enrolled with depression (849 women and 985 men).Intervention: Use of antidepressant medication.Main Outcome Measures: Event-free survival was defined as the absence of death or recurrent MI. All-cause mortality was also examined. To relate exposure to antidepressants to subsequent morbidity and mortality, the data were analyzed using a time-dependent covariate model.Results. During a mean follow-up of 29 months, 457 fatal and nonfatal cardiovascular events occurred. The risk of death or recurrent MI was significantly lower in patients taking selective serotonin reuptake inhibitors (adjusted hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.38-0.84), as were the risk of all-cause mortality (adjusted HR, 0.59; 95% CI, 0.37-0.96) and recurrent MI (adjusted HR, 0.53; 95% Cl, 0.32-0.90), compared with patients who did not use selective serotonin reuptake inhibitors. For patients taking non-selective serotonin reuptake inhibitor antidepressants, the comparable HRs (95% CIS) were 0.72 (0.44-1.18), 0.64 (0.34-1.22), and 0.73 (0.38-1.38) for risk of death or recurrent MI, all-cause mortality, or recurrent MI, respectively, compared with nonusers.Conclusions: Use of selective serotonin reuptake inhibitors in depressed patients who experience an acute MI might reduce subsequent cardiovascular morbidity and mortality. A controlled trial is needed to examine this important issue.