Connerney I, Shapiro P A, McLaughlin J S, Bagiella E, Sloan R P
Mailman School of Public Health, Columbia University, New York, NY, USA.
Lancet. 2001 Nov 24;358(9295):1766-71. doi: 10.1016/S0140-6736(01)06803-9.
The association of depression with cardiac events has been investigated mainly in community cohorts, in patients undergoing catheterisation, or in patients who have had myocardial infarction. We have assessed the effect of depression on outcomes after coronary artery bypass graft (CABG) surgery.
In a prospective study, we followed up for 1 year 207 men and 102 women, who had undergone coronary artery bypass graft surgery. We assessed depression with a structured psychiatric interview (diagnostic interview schedule) and a questionnaire (Beck depression inventory) before discharge. Cardiac events included angina or heart failure that needed admission to hospital, myocardial infarction, cardiac arrest, percutaneous transluminal coronary angioplasty, repeat CABG, and cardiac mortality. Non-cardiac events consisted of all other reasons for mortality or readmission.
63 patients (20%) met modified diagnostic statistical manual IV criteria for major depressive disorder. At 12 months, 17 (27%) of these patients had a cardiac event compared with 25 of 246 (10%) who were not depressed (p<0.0008). Five variables had significant univariate associations with cardiac events: sex, living alone, low ejection fraction (<0.35), length of hospital stay, and depression. In a Cox proportional-hazard model with these five and two other variables of cardiac severity, major depressive disorder (risk ratio 2.3 [95% CI 1.17-4.56]), low ejection fraction (2.3 [1.07-5.03]), and female sex (2.4 [1.24-4.44]) were associated with adverse outcomes. Depression did not predict deaths or admissions for non-cardiac events.
Depression is an important independent risk factor for cardiac events after CABG surgery.
抑郁症与心脏事件之间的关联主要在社区队列、接受导管插入术的患者或心肌梗死患者中进行了研究。我们评估了抑郁症对冠状动脉旁路移植术（CABG）后结局的影响。
在一项前瞻性研究中，我们对207名男性和102名女性进行了为期1年的随访，这些患者均接受了冠状动脉旁路移植手术。我们在出院前通过结构化精神科访谈（诊断访谈表）和问卷（贝克抑郁量表）评估抑郁症。心脏事件包括需要住院治疗的心绞痛或心力衰竭、心肌梗死、心脏骤停、经皮冠状动脉腔内血管成形术、再次冠状动脉旁路移植术和心脏死亡。非心脏事件包括所有其他导致死亡或再次入院的原因。
63名患者（20%）符合《精神疾病诊断与统计手册》第四版修订版中重度抑郁症的标准。在12个月时，这些患者中有17名（27%）发生了心脏事件，而246名未患抑郁症的患者中有25名（10%）发生了心脏事件（p<0.0008）。有五个变量与心脏事件存在显著的单变量关联：性别、独居、低射血分数（<0.35）、住院时间和抑郁症。在一个包含这五个变量以及另外两个心脏严重程度变量的Cox比例风险模型中，重度抑郁症（风险比2.3 [95%置信区间1.17 - 4.56]）、低射血分数（2.3 [1.07 - 5.03]）和女性性别（2.4 [1.24 - 4.44]）与不良结局相关。抑郁症并不能预测非心脏事件导致的死亡或入院情况。
抑郁症是冠状动脉旁路移植术后心脏事件的一个重要独立危险因素。
