Time course of depression and outcome of myocardial infarction
Time course of depression and outcome of myocardial infarction
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DOI：
10.1001/archinte.166.18.2035
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发表时间：
2006-10-09
影响因子：
--
通讯作者：
Vaccarino, Viola
中科院分区：
文献类型：
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作者：
Parashar, Susmita;Rumsfeld, John S.;Vaccarino, Viola
背景资料：心肌梗死（MI）后抑郁预示预后不良，但MI后一个月抑郁的时间进程是否具有预后重要性尚不清楚。我们的目的是评估短暂的、新发的或持续的抑郁对MI后6个月预后的重要性。（评价心肌梗死后结局的前瞻性登记研究：事件和恢复[PREMIER]），采用患者健康问卷（PHQ）对1873例患者的抑郁症状进行了测量在住院期间和出院后1个月，被分类为一过性（仅在基线时）、新发（仅在1个月时）或持续性（在两个时间点）。6个月时的结局包括（1）全因再住院或死亡率和（2）健康状况（心绞痛、身体限制和生活质量，使用西雅图心绞痛问卷）。结果：与非抑郁症患者相比，所有类型的抑郁症患者均与更高的再住院或死亡率、更频繁的心绞痛、更多的身体限制和更差的生活质量相关。短暂性抑郁、新发抑郁和持续性抑郁患者再住院或死亡的校正风险比分别为1.34、1.71和1.42（均P <0.05）。心绞痛的相应比值比分别为1.62、2.73和2.64（均P <0.01），体力受限的相应比值比分别为1.69、2.25和3.27（均P <0.05）。抑郁症状表现出较强的关联与健康状况相比，传统的措施，疾病severity.Conclusion：MI后的抑郁症状，无论他们是否持续存在，消退，或新开发的第一个月住院后，与MI后的不良后果。
Background: Depression predicts worse outcomes after myocardial infarction (MI), but whether its time course in the month following MI has prognostic importance is unknown. Our objective was to evaluate the prognostic importance of transient, new, or persistent depression on outcomes at 6 months after MI.Methods: In a prospective registry of acute MI ( Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery [PREMIER]), depressive symptoms were measured in 1873 patients with the Patient Health Questionnaire (PHQ) during hospitalization and 1 month after discharge and were classified as transient (only at baseline), new (only at 1 month), or persistent (at both times). Outcomes at 6 months included (1) all-cause rehospitalization or mortality and (2) health status (angina, physical limitation, and quality of life using the Seattle Angina Questionnaire).Results: Compared with nondepressed patients, all categories of depression were associated with higher rehospitalization or mortality rates, more frequent angina, more physical limitations, and worse quality of life. The adjusted hazard ratios for rehospitalization or mortality were 1.34, 1.71, and 1.42 for transient, new, and persistent depression, respectively (all P < .05). Corresponding odds ratios were 1.62, 2.73, and 2.64 (all P < .01) for angina and 1.69, 2.25, and 3.27 (all P < .05) for physical limitation. Depressive symptoms showed a stronger association with health status compared with traditional measures of disease severity.Conclusion: Depressive symptoms after MI, irrespective of whether they persist, subside, or newly develop in the first month after hospitalization, are associated with worse outcomes after MI.