Carney Robert M, Freedland Kenneth E, Steinmeyer Brian, Blumenthal James A, de Jonge Peter, Davidson Karina W, Czajkowski Susan M, Jaffe Allan S
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA.
Psychosom Med. 2009 Apr;71(3):253-9. doi: 10.1097/PSY.0b013e31819b69e3. Epub 2009 Feb 27.
To compare survival in post-myocardial (MI) participants from the Enhancing Recovery In Coronary Heart Disease (ENRICHD) clinical trial with a first episode of major depression (MD) and those with recurrent MD, which is a risk factor for mortality after acute MI. Recent reports suggest that the level of risk may depend on whether the comorbid MD is a first or a recurrent episode.
Survival was compared over a median of 29 months in 370 patients with an initial episode of MD, 550 with recurrent MD, and 408 who were free of depression.
After adjusting for an all-cause mortality risk score, initial Beck Depression Inventory score, and the use of selective serotonin reuptake inhibitor antidepressants, patients with a first episode of MD had poorer survival (18.4% all-cause mortality) than those with recurrent MD (11.8%) (hazard ratio (HR) = 1.4; 95% Confidence Interval (CI) = 1.0-2.0; p = .05). Both first depression (HR = 3.1; 95% CI = 1.6-6.1; p = .001) and recurrent MD (HR = 2.2; 95% CI = 1.1-4.4; p = .03) had significantly poorer survival than did the nondepressed patients (3.4%). A secondary analysis of deaths classified as probably due to a cardiovascular cause resulted in similar HRs, but the difference between depression groups was not significant.
Both initial and recurrent episodes of MD predict shorter survival after acute MI, but initial MD episodes are more strongly predictive than recurrent episodes. Exploratory analyses suggest that this cannot be explained by more severe heart disease at index, poorer response to depression treatment, or a higher risk of cerebrovascular disease in patients with initial MD episodes.
比较冠心病强化康复（ENRICHD）临床试验中首次发生重度抑郁症（MD）的心肌梗死（MI）后参与者与复发性MD参与者的生存率，复发性MD是急性心肌梗死后死亡的一个危险因素。最近的报告表明，风险水平可能取决于合并的MD是首次发作还是复发发作。
比较了370例首次发作MD的患者、550例复发性MD的患者和408例无抑郁症患者在29个月中位数时间内的生存率。
在调整了全因死亡风险评分、初始贝克抑郁量表评分以及选择性5-羟色胺再摄取抑制剂抗抑郁药的使用情况后，首次发作MD的患者生存率（全因死亡率18.4%）低于复发性MD患者（11.8%）（风险比（HR）=1.4；95%置信区间（CI）=1.0-2.0；p=0.05）。首次抑郁症（HR=3.1；95%CI=1.6-6.1；p=0.001）和复发性MD（HR=2.2；95%CI=1.1-4.4；p=0.03）的生存率均显著低于无抑郁症患者（3.4%）。对归类为可能由心血管原因导致的死亡进行的二次分析得出了类似的HR，但抑郁组之间的差异并不显著。
MD的首次发作和复发发作均预示着急性心肌梗死后生存期较短，但首次MD发作的预测性比复发发作更强。探索性分析表明，这不能用首次发作时更严重的心脏病、对抑郁症治疗的反应较差或首次发作MD患者中更高的脑血管疾病风险来解释。
