Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study
Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study
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DOI：
10.1097/01.psy.0000133362.75075.a6
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发表时间：
2004-07-01
影响因子：
3.3
通讯作者：
Jaffe, AS
中科院分区：
文献类型：
--
作者：
Carney, RM;Blumenthal, JA;Jaffe, AS
目的：冠心病康复增强研究是一项多中心临床试验，在该试验中，急性心肌梗死后患有抑郁症和/或感知社会支持较低的患者被随机分配到由认知行为疗法（在某些情况下还包括舍曲林）组成的干预组或常规护理组。两组之间的生存率没有差异。干预措施未能影响生存率的一个可能原因是纳入了太多轻度、短暂性抑郁症患者。另一个原因是一些患者过早死亡，未能完成干预。本分析评估了在贝克抑郁量表评分≥10且有重度抑郁症既往史并完成治疗后6个月评估的初始抑郁症患者中，晚期（即心肌梗死后≥6个月）死亡率是否存在差异。它还研究了抑郁变化与晚期死亡率之间的关系。方法：在冠心病康复增强研究的参与者中，符合我们标准的有1165人（47%），其中57人在最初的6个月内死亡，858人（409人接受常规护理，449人接受干预）完成了6个月的评估。采用考克斯回归分析生存率。结果：干预措施不影响晚期死亡率。然而，抑郁未改善的干预组患者比治疗有反应的患者晚期死亡风险更高。结论：对认知行为疗法和舍曲林（两种抑郁症标准治疗方法）无反应的抑郁症患者在心肌梗死后晚期死亡的风险较高。
Objective: The Enhancing Recovery in Coronary Heart Disease study was a multicenter clinical trial in which patients with depression and/or low perceived social support after an acute myocardial infarction were randomly assigned to an intervention consisting of cognitive behavior therapy and, in some cases, sertraline, or to usual care. There was no difference in survival between the groups. A possible reason why the intervention failed to affect survival is that too many patients with mild, transient depression were enrolled. Another is that some patients died too soon to complete the intervention. This analysis evaluates whether there was a difference in late (ie, greater than or equal to6 months after the myocardial infarction) mortality among initially depressed patients who had a Beck Depression Inventory score greater than or equal to10 and a past history of major depression, and who completed the 6-month post-treatment assessment. It also examines the relationship between change in depression and late mortality. Methods: Out of the 1,165 (47%) of the Enhancing Recovery in Coronary Heart Disease study participants who met our criteria, 57 died in the first 6 months, and 858 (409 usual care, 449 intervention) completed the 6-month assessment. Cox regression was used to analyze survival. Results: The intervention did not affect late mortality. However, intervention patients whose depression did not improve were at higher risk for late mortality than were patients who responded to treatment. Conclusions: Patients whose depression is refractory to cognitive behavior therapy and sertraline, two standard treatments for depression, are at high risk for late mortality after myocardial infarction.