Depression as a risk factor for mortality after coronary artery bypass surgery
Depression as a risk factor for mortality after coronary artery bypass surgery
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DOI：
10.1016/s0140-6736(03)14190-6
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发表时间：
2003-08-23
期刊：
影响因子：
168.9
通讯作者：
Newman, MF
中科院分区：
文献类型：
--
作者：
Blumenthal, JA;Lett, HS;Newman, MF
研究表明临床抑郁是冠状动脉旁路移植术（CABG）后心脏事件的危险因素，但样本量小，随访时间短，没有足够的把握度来评估死亡率。我们试图评估抑郁症是否与死亡风险增加有关。方法我们评估了1989年5月至2001年5月在杜克大学医学中心接受CABG的817例患者。患者完成了流行病学抑郁症（CES-D）量表术前，6个月后冠状动脉旁路移植术，并随访了长达12 years.Findings在817例患者中，有122例死亡（15%），平均随访5.2年。310例患者（38%）符合抑郁标准（CES-D ≥ 16）：213例（26%）为轻度抑郁（CES-D 16-26），97例（12%）为中度至重度抑郁（CES-D ≥ 27）。控制年龄、性别、移植物数量、糖尿病、吸烟、左心室射血分数和既往心肌梗死的生存分析显示，基线时有中度至重度抑郁的患者（调整后的风险比[HR] 2.4，[95% CI 1.4-4.0]; p=0.001）和轻度或中度至重度抑郁，从基线持续至6个月（调整后HR 2.2，[1.2-4.2]; p=0.015）的死亡率高于没有抑郁症的患者。解释尽管冠状动脉旁路移植术后患者的手术和药物管理取得了进展，抑郁是CABG术后死亡的重要独立预测因素，应仔细监测并在必要时进行治疗。
Background Studies that have shown clinical depression to be a risk factor for cardiac events after coronary artery bypass graft (CABG) surgery have had small sample sizes, short follow-up, and have not had adequate power to assess mortality. We sought to assess whether depression is associated with an increased risk of mortality.Methods We assessed 817 patients undergoing CABG at Duke University Medical Center between May, 1989, and May, 2001. Patients completed the Center for Epidemiological Studies-Depression (CES-D) scale before surgery, 6 months after CABG, and were followed-up for up to 12 years.Findings In 817 patients there were 122 deaths (15%) in a mean follow-up of 5.2 years. 310 patients (38%) met the criterion for depression (CES-D greater than or equal to16): 213 (26%) for mild depression (CES-D 16-26) and 97 (12%) for moderate to severe depression (CES-D greater than or equal to27). Survival analyses, controlling for age, sex, number of grafts, diabetes, smoking, left ventricular ejection fraction, and previous myocardial infarction, showed that patients with moderate to severe depression at baseline (adjusted hazard ratio [HR] 2.4, [95% CI 1.4-4.0]; p=0.001) and mild or moderate to severe depression that persisted from baseline to 6 months (adjusted HR 2.2, [1.2-4.2]; p=0.015) had higher rates of death than did those with no depression.Interpretation Despite advances in surgical and medical management of patients after CABG, depression is an important independent predictor of death after CABG and should be carefully monitored and treated if necessary.