Rumsfeld John S, Magid David J, Plomondon Mary E, Sales Anne E, Grunwald Gary K, Every Nathan R, Spertus John A
Cardiology, Denver VA Medical Center, Denver, Colo 80206, USA.
Am Heart J. 2003 Mar;145(3):493-9. doi: 10.1067/mhj.2003.177.
Depression has been associated with higher mortality and morbidity rates after acute coronary syndromes (ACS), but little is known about the association between depression, angina burden, and quality of life. We evaluated the association between a history of depression and patient-reported angina frequency, physical limitation, and quality of life 7 months after discharge from the hospital for ACS.
Patients were enrolled in the Department of Veterans Affairs Access to Cardiology Study, a cohort study of all patients with acute myocardial infarction or unstable angina who were discharged from 24 Veterans Affairs medical centers between March 1998 and February 1999. Data from 1957 patients who completed a 7-month postdischarge Seattle Angina Questionnaire were analyzed. Multivariate logistic regression was used to evaluate a history of depression as an independent predictor of angina frequency, physical limitation, and quality of life 7 months after ACS, as measured with the Seattle Angina Questionnaire.
A total of 526 patients (26.7%) had a history of depression. After adjustment for a wide array of demographic, cardiac, and comorbid factors, a history of depression was significantly associated with more frequent angina (odds ratio [OR] 2.40, 95% CI 1.86-3.10, P <.001), greater physical limitation (OR 2.89, 95% CI 2.17-3.86, P <.001), and worse quality of life (OR 2.84, 95% CI 2.16-3.72, P <.001) after ACS.
We found a strong association between a history of depression and both heavier angina burden and worse health status after ACS. These findings further support the importance of depression as a risk marker for adverse outcomes after ACS.
抑郁症与急性冠状动脉综合征（ACS）后的较高死亡率和发病率相关，但关于抑郁症、心绞痛负担和生活质量之间的关联却知之甚少。我们评估了抑郁症病史与患者报告的ACS出院7个月后的心绞痛频率、身体限制和生活质量之间的关联。
患者参加了退伍军人事务部心脏病学研究项目，这是一项对1998年3月至1999年2月期间从24个退伍军人事务医疗中心出院的所有急性心肌梗死或不稳定型心绞痛患者进行的队列研究。对1957名完成出院后7个月西雅图心绞痛问卷的患者的数据进行了分析。采用多因素逻辑回归来评估抑郁症病史作为ACS后7个月心绞痛频率、身体限制和生活质量的独立预测因素，这些指标通过西雅图心绞痛问卷进行测量。
共有526名患者（26.7%）有抑郁症病史。在对一系列人口统计学、心脏和合并症因素进行调整后，抑郁症病史与更频繁的心绞痛（优势比[OR]2.40，95%可信区间1.86 - 3.10，P <.001）、更大的身体限制（OR 2.89，95%可信区间2.17 - 3.86，P <.001）以及ACS后更差的生活质量（OR 2.84，95%可信区间2.16 - 3.72，P <.001）显著相关。
我们发现抑郁症病史与ACS后更严重的心绞痛负担和更差的健康状况之间存在密切关联。这些发现进一步支持了抑郁症作为ACS后不良结局风险标志物的重要性。
