DEPRESSION AND MORTALITY FOLLOWING MYOCARDIAL INFARCTION

描述：临床抑郁症是导致死亡的一个重要风险因素。 急性心肌梗死(MI)后，人们对此知之甚少 解释这一效应的潜在机制。的主要目的是 这项研究是为了检验最有可能的候选机制之一， 改变了自主神经的音调。480例心肌梗塞后患者的DSM-IV测评 重度或轻度抑郁症患者参加了美国国家卫生研究院 NHLBI赞助的ENRICHD(促进冠心病康复) 临床试验，排除480名非抑郁的心肌梗死后患者 EnRICHD，将在两年内被招募参加这项研究，从四个 恩里希德临床中心。24小时动态心电图会记录下来 出院获取心率变异性、心肌梗死的数据 缺血和室性心律失常。患者将在18岁时接受随访 几个月，心理社会和医学终点，包括死亡率，将是 已经确定了。初步分析将决定心率是否 可变性解释了预期的更高的死亡率 抑郁组与非抑郁组比较，以及这种影响是否 主要集中在室性心律失常和左 心功能不全。 研究的第二个目的是确定临床特征或亚型。 可能与特别高的死亡风险有关的抑郁症 以及自主神经音调的改变，如症状严重程度，共病焦虑， 或敌意。这一机制研究将补充临床数据，以 是从ENRICHD试验中获得的，而且它的成本会高得多 而且很难独立进行可比较的研究。澄清 基本机制将极大地增强 抑郁症增加心肌梗死后死亡率的流行病学证据 患者，并允许进一步细化风险分层，以便 最高风险的患者可以被识别和治疗最多 咄咄逼人。

DESCRIPTION: Clinical depression is a powerful risk factor for mortality after an acute myocardial infarction (MI), yet little is known about the underlying mechanisms that account for this effect. The primary purpose of this study is to examine one of the most plausible candidate mechanisms, altered autonomic tone. Four hundred eighty post-MI patients with DSM-IV major or minor depression who are enrolled in the Usual Care arm of the NHLBI-sponsored ENRICHD (Enhancing Recovery in Coronary Heart Disease) clinical trial, and 480 non-depressed post-MI patients excluded from ENRICHD, will be recruited for this study during a two year period from four ENRICHD clinical centers. A 24 hour ambulatory ECG will be recorded after hospital discharge to obtain data on heart rate variability, myocardial ischemia, and ventricular arrhythmias. Patients will be followed up at 18 months, and psychosocial and medical endpoints, including mortality, will be ascertained. The primary analysis will determine whether heart rate variability accounts for the significantly higher mortality expected in the depressed compared to the non-depressed group, and whether this effect is largely concentrated in patients with ventricular arrhythmias and left ventricular dysfunction. The second purpose of the study is to identify clinical features or subtypes of depression that may be associated with a particularly high mortality risk and with altered autonomic tone, such as symptom severity, comorbid anxiety, or hostility. This mechanistic study will complement the clinical data to be obtained from the ENRICHD trial, and it would be considerably more costly and difficult to conduct a comparable study independently. Clarification of the underlying mechanism will greatly enhance the credibility of the epidemiological evidence that depression increases mortality in post-MI patients, and permit further refinements in risk stratification so that the patients at highest risk can be identified and treated the most aggressively.