Parashar Susmita, Rumsfeld John S, Spertus John A, Reid Kimberly J, Wenger Nanette K, Krumholz Harlan M, Amin Alpesh, Weintraub William S, Lichtman Judith, Dawood Nazeera, Vaccarino Viola
Divisions of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
Arch Intern Med. 2006 Oct 9;166(18):2035-43. doi: 10.1001/archinte.166.18.2035.
Depression predicts worse outcomes after myocardial infarction (MI), but whether its time course in the month following MI has prognostic importance is unknown. Our objective was to evaluate the prognostic importance of transient, new, or persistent depression on outcomes at 6 months after MI.
In a prospective registry of acute MI (Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery [PREMIER]), depressive symptoms were measured in 1873 patients with the Patient Health Questionnaire (PHQ) during hospitalization and 1 month after discharge and were classified as transient (only at baseline), new (only at 1 month), or persistent (at both times). Outcomes at 6 months included (1) all-cause rehospitalization or mortality and (2) health status (angina, physical limitation, and quality of life using the Seattle Angina Questionnaire).
Compared with nondepressed patients, all categories of depression were associated with higher rehospitalization or mortality rates, more frequent angina, more physical limitations, and worse quality of life. The adjusted hazard ratios for rehospitalization or mortality were 1.34, 1.71, and 1.42 for transient, new, and persistent depression, respectively (all P<.05). Corresponding odds ratios were 1.62, 2.73, and 2.64 (all P<.01) for angina and 1.69, 2.25, and 3.27 (all P<.05) for physical limitation. Depressive symptoms showed a stronger association with health status compared with traditional measures of disease severity.
Depressive symptoms after MI, irrespective of whether they persist, subside, or newly develop in the first month after hospitalization, are associated with worse outcomes after MI.
抑郁症预示着心肌梗死（MI）后预后更差，但在MI后的一个月内其病程是否具有预后重要性尚不清楚。我们的目的是评估短暂性、新发或持续性抑郁症对MI后6个月结局的预后重要性。
在急性心肌梗死前瞻性登记研究（心肌梗死事件和恢复前瞻性登记研究[PREMIER]）中，1873例患者在住院期间和出院后1个月使用患者健康问卷（PHQ）测量抑郁症状，并分为短暂性（仅在基线时）、新发（仅在1个月时）或持续性（在两个时间点均有）。6个月时的结局包括：（1）全因再住院或死亡；（2）健康状况（心绞痛、身体限制以及使用西雅图心绞痛问卷评估的生活质量）。
与无抑郁患者相比，所有类型的抑郁症均与更高的再住院或死亡率、更频繁的心绞痛、更多的身体限制以及更差的生活质量相关。短暂性、新发和持续性抑郁症再住院或死亡的校正风险比分别为1.34、1.71和1.42（均P<0.05）。心绞痛的相应比值比分别为1.62、2.73和2.64（均P<0.01），身体限制的相应比值比分别为1.69、2.25和3.27（均P<0.05）。与传统的疾病严重程度测量指标相比，抑郁症状与健康状况的关联更强。
MI后的抑郁症状，无论在住院后的第一个月是持续、缓解还是新发，均与MI后更差的结局相关。
