Association of Anhedonia With Recurrent Major Adverse Cardiac Events and Mortality 1 Year After Acute Coronary Syndrome
Association of Anhedonia With Recurrent Major Adverse Cardiac Events and Mortality 1 Year After Acute Coronary Syndrome
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DOI：
10.1001/archgenpsychiatry.2010.36
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发表时间：
2010-05-01
影响因子：
--
通讯作者：
Rieckmann, Nina
中科院分区：
文献类型：
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作者：
Davidson, Karina W.;Burg, Matthew M.;Rieckmann, Nina
内容：抑郁一直预测急性冠脉综合征（ACS）患者的复发事件和死亡率，但它有两个具有明显生物学相关性的核心诊断标准-抑郁情绪和快感缺乏目的：确定抑郁情绪和/或快感缺乏是否能预测ACS患者1年的医疗结果。设计：2003年5月至2005年6月期间住院的ACS后患者的观察性队列研究。在入院后1周内，患者接受了结构化的精神病学访谈，评估临床损害抑郁情绪、快感缺乏和重度抑郁发作（MDE）。同时评估了急性冠脉事件风险评分、Charlson合并症指数、左心室射血分数、抗抑郁药使用情况和使用Beck抑郁量表的抑郁症状严重程度。设置：纽约和康涅狄格州3所大学医院的心脏科。参与者：453例ACS患者的对比样本（年龄25-93岁; 42%为女性）。主要结局指标：入院后1年主动调查全因死亡率（ACM）和记录的主要不良心脏事件（MACE）（心肌梗死、因不稳定型心绞痛住院或紧急/急诊冠状动脉血运重建）。共发生67起事件（16例死亡和51例MACE; 14.8%）：分别有108例（24%）和77例（17%）患者发生快感缺乏和抑郁情绪。控制性别、年龄和医学协变量后，快感缺乏（校正后的危险比，1.58; 95%可信区间，1.16-2.14; P
Context: Depression consistently predicts recurrent events and mortality in patients with acute coronary syndrome (ACS), but it has 2 core diagnostic criteria with distinct biological correlates-depressed mood and anhedonia (loss of pleasure or interest).Objective: To determine if depressed mood and/or anhedonia predict 1-year medical outcomes for patients with ACS.Design: Observational cohort study of post-ACS patients hospitalized between May 2003 and June 2005. Within 1 week of admission, patients underwent a structured psychiatric interview assessing clinically impairing depressed mood, anhedonia, and major depressive episode (MDE). Also assessed were the Global Registry of Acute Coronary Events risk score, Charlson comorbidity index, left ventricular ejection fraction, antidepressant use, and depressive symptom severity using the Beck Depression Inventory.Setting: Cardiac units of 3 university hospitals in New York and Connecticut.Participants: Consecutive sample of 453 patients with ACS (age, 25-93 years; 42% women).Main Outcomes Measures: All-cause mortality (ACM) and documented major adverse cardiac events (MACEs)myocardial infarction, hospitalization for unstable angina, or urgent/emergency coronary revascularization)actively surveyed for 1 year after admission.Results: There were 67 events (16 deaths and 51 MACEs; 14.8%): 108 (24%) and 77 (17%) patients had anhedonia and depressed mood, respectively. Controlling for sex, age, and medical covariates, anhedonia (adjusted hazard ratio, 1.58; 95% confidence interval, 1.16-2.14; P