Rumsfeld John S, Jones Philip G, Whooley Mary A, Sullivan Mark D, Pitt Bertram, Weintraub William S, Spertus John A
Section of Cardiology, Denver VA Medical Center, Denver, Colorado 80220, USA.
Am Heart J. 2005 Nov;150(5):961-7. doi: 10.1016/j.ahj.2005.02.036.
To evaluate whether depressive symptoms are independently predictive of mortality and hospitalization among patients with acute myocardial infarction (AMI) complicated by heart failure.
The EPHESUS trial enrolled patients with AMI complicated by heart failure. Patients from Canada, the UK, and the United States completed a Medical Outcomes Study-Depression questionnaire at baseline in addition to a comprehensive clinical examination. Cox proportional hazards regression was used to determine the relationship between depressive symptoms and outcomes, including 2-year all-cause mortality and cardiovascular death or hospitalization, adjusting for baseline clinical variables.
Overall, 143 of 634 patients (22.6%) had significant depressive symptoms at baseline (Medical Outcomes Study-Depression score > or = 0.06). Depressed patients had higher 2-year mortality (29% vs 18%; P = .004) and cardiovascular death or hospitalization (42% vs 33%; P = .016). After risk adjustment, depressive symptoms remained significantly associated with mortality (hazard ratio 1.75, 95% CI 1.15-2.68, P = .01) and cardiovascular death or hospitalization (hazard ratio 1.41, 95% CI 1.03-1.93, P = .03). Results were consistent across demographic and clinical subgroups.
Depression is an independent predictor of all-cause mortality and cardiovascular death or hospitalization after AMI complicated by heart failure. Although many factors may mediate outcomes in patients with AMI, studies are warranted to evaluate whether a depression intervention can improve survival and/or reduce hospitalizations.
评估急性心肌梗死（AMI）合并心力衰竭患者的抑郁症状是否能独立预测死亡率和住院率。
EPHESUS试验纳入了AMI合并心力衰竭的患者。来自加拿大、英国和美国的患者在基线时除了进行全面的临床检查外，还完成了一份医学结局研究-抑郁问卷。采用Cox比例风险回归分析来确定抑郁症状与结局之间的关系，结局包括2年全因死亡率以及心血管死亡或住院率，并对基线临床变量进行了调整。
总体而言，634例患者中有143例（22.6%）在基线时存在显著的抑郁症状（医学结局研究-抑郁评分≥0.06）。抑郁患者的2年死亡率更高（29%对18%；P = 0.004），心血管死亡或住院率也更高（42%对33%；P = 0.016）。在进行风险调整后，抑郁症状仍与死亡率显著相关（风险比1.75，95%置信区间1.15 - 2.68，P = 0.01）以及心血管死亡或住院率显著相关（风险比1.41，95%置信区间1.03 - 1.93，P = 0.03）。在不同人口统计学和临床亚组中结果均一致。
抑郁是AMI合并心力衰竭后全因死亡率以及心血管死亡或住院率的独立预测因素。尽管许多因素可能影响AMI患者的结局，但仍有必要开展研究以评估抑郁干预是否能够改善生存率和/或减少住院率。
