Ladwig K H, Kieser M, König J, Breithardt G, Borggrefe M
Institut und Poliklinik für Psychosomat. Med., Psych. Ther. u. Med. Psychol., Technischen Universität München, Germany.
Eur Heart J. 1991 Sep;12(9):959-64.
Psychological data from 560 male survivors of acute myocardial infarction (AMI) were documented in the third week after onset of AMI. The psychodiagnostic assessment was designed to detect different forms of depression as well as hyperactive behaviour. A complete follow-up of these patients, which covers a period of 6 months, is available. Our findings indicate that affective disorders play an important role in the post-acute phase after AMI although the extent of myocardial infarction (as defined by an ECG score) and behaviour responses are not significantly related to one another. Different subforms of depression are not influenced by a history of angina pectoris, the degree and location of myocardial infarction, the occurrence of late potentials and age, whereas dyspnoea (P less than 0.001) and the recurrence of myocardial infarction (P less than 0.001) favour depressive mood states. Twelve cardiac deaths and 17 arrhythmic events occurred during the study period; they were significantly predicted by severe forms of post-AMI depression as revealed by univariate analysis. The evidence was stronger for predicting cardiac death (P less than 0.001) than for arrhythmic events (P = less than 0.035). The effect remains of borderline significance for cardiac death if all risk factors with a significant univariate influence are included in a multiple logistic regression model. The effect of depression is illustrated by Kaplan-Meier survival curves separated for patient groups with high as compared to low degrees of depression. Hyperactivity showed no impact on patient survival.
对560名急性心肌梗死（AMI）男性幸存者的心理数据记录于AMI发病后的第三周。心理诊断评估旨在检测不同形式的抑郁以及多动行为。对这些患者进行了为期6个月的完整随访。我们的研究结果表明，情感障碍在AMI后的急性期后起着重要作用，尽管心肌梗死的程度（由心电图评分定义）与行为反应之间没有显著相关性。不同亚型的抑郁不受心绞痛病史、心肌梗死的程度和位置、晚电位的出现以及年龄的影响，而呼吸困难（P<0.001）和心肌梗死复发（P<0.001）则易引发抑郁情绪状态。在研究期间发生了12例心源性死亡和17例心律失常事件；单因素分析显示，AMI后严重抑郁形式可显著预测这些事件。预测心源性死亡（P<0.001）的证据比预测心律失常事件（P<0.035）更强。如果将所有具有显著单因素影响的风险因素纳入多元逻辑回归模型，抑郁对心源性死亡的影响仍具有临界显著性。通过将抑郁程度高的患者组与抑郁程度低的患者组的Kaplan-Meier生存曲线分开，说明了抑郁的影响。多动对患者生存没有影响。
