Pedersen Susanne S, Ong Andrew T L, Sonnenschein Karel, Serruys Patrick W, Erdman Ruud A M, van Domburg Ron T
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Am Heart J. 2006 Feb;151(2):367.e1-367.e6. doi: 10.1016/j.ahj.2005.08.012.
Depression is common in cardiac patients and has been associated with adverse clinical outcome. However, little is known about predictors of the onset of depressive symptoms. We examined predictors of the onset of depressive symptoms at 12 months post-percutaneous coronary intervention (PCI) in patients treated in the drug-eluting stent era.
Unselected patients, free from depressive symptoms at 6 months with a depression score at 12 months treated with PCI with either drug-eluting or bare stent implantation as part of the RESEARCH registry qualified for inclusion in the current study. Patients completed the Hospital Anxiety and Depression Scale at 6 and 12 months and the Type D Personality Scale (DS14) at 6 months post-PCI. Six months was used as the baseline assessment.
Of 542 patients, 41 (8%) had developed significant depressive symptoms at 12 months. The occurrence of a new cardiac event between 6 and 12 months post-index event did not influence the incidence of depressive symptoms at 12 months. Depressive patients were more likely to have a type D personality (34% vs 16%, P = .003) and diabetes (24% vs 11%, P = .01) than nondepressive patients. Type D personality (odds ratio 3.04, 95% CI 1.50-6.16) and diabetes (odds ratio 2.75, 95% CI 1.25-6.05) were independent predictors of the onset of depressive symptoms 12 months post-PCI in adjusted analyses. In patients with neither risk factors (type D or diabetes), the incidence of depression was 5.1% with the incidence more than doubling to 13.2% and 30% for each additional risk factor.
Type D personality and diabetes comprise risk factors for the onset of depressive symptoms post-PCI. In clinical practice, patients with these risk factors should be identified and considered for psychosocial intervention targeting depression to enhance secondary prevention.
抑郁症在心脏病患者中很常见，且与不良临床结局相关。然而，对于抑郁症状发作的预测因素知之甚少。我们研究了在药物洗脱支架时代接受经皮冠状动脉介入治疗（PCI）的患者在术后12个月时抑郁症状发作的预测因素。
作为RESEARCH注册研究的一部分，未经过筛选的患者在6个月时无抑郁症状，在12个月时接受了药物洗脱支架或裸支架植入的PCI治疗且有抑郁评分，符合纳入本研究的条件。患者在术后6个月和12个月完成医院焦虑抑郁量表评估，并在PCI术后6个月完成D型人格量表（DS14）评估。以6个月时作为基线评估。
在542例患者中，41例（8%）在12个月时出现了明显的抑郁症状。在索引事件后6至12个月内发生的新心脏事件并未影响12个月时抑郁症状的发生率。与非抑郁患者相比，抑郁患者更有可能具有D型人格（34%对16%，P = 0.003）和糖尿病（24%对11%，P = 0.01）。在调整分析中，D型人格（优势比3.04，95%可信区间1.50 - 6.16）和糖尿病（优势比2.75，95%可信区间1.25 - 6.05）是PCI术后12个月抑郁症状发作的独立预测因素。在没有任何一种危险因素（D型人格或糖尿病）的患者中，抑郁症的发生率为5.1%，每增加一种危险因素，发生率就会增加一倍多，分别达到13.2%和30%。
D型人格和糖尿病是PCI术后抑郁症状发作的危险因素。在临床实践中，应识别出具有这些危险因素的患者，并考虑针对抑郁症进行社会心理干预，以加强二级预防。
