Parashar Susmita, Rumsfeld John S, Reid Kimberly J, Buchanan Donna, Dawood Nazeera, Khizer Saadia, Lichtman Judith, Vaccarino Viola
Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307, USA.
Circ Cardiovasc Qual Outcomes. 2009 Jan;2(1):33-40. doi: 10.1161/CIRCOUTCOMES.108.818500. Epub 2009 Jan 6.
Women have an unexplained worse outcome after myocardial infarction (MI) compared with men in many studies. Depressive symptoms predict adverse post-MI outcomes and are more prevalent among women than men. We examined whether depressive symptoms contribute to women's worse outcomes after MI.
In a prospective multicenter study (PREMIER), 2411 (807 women) MI patients were enrolled. Depressive symptoms were assessed with the Patient Health Questionnaire. Outcomes included 1-year rehospitalization, presence of angina using the Seattle Angina Questionnaire, and 2-year mortality. Multivariable analyses were used to evaluate the association between sex and these outcomes, adjusting for clinical characteristics. The depressive symptoms score was added to the models to evaluate whether it attenuated the association between sex and outcomes. Depressive symptoms were more prevalent in women compared with men (29% versus 18.8%, P<0.001). After adjusting for demographic factors, comorbidities, and MI severity, women had a mildly higher risk of rehospitalization (hazard ratio, 1.20; 95% CI, 1.04 to 1.40), angina (odds ratio, 1.32; 95% CI, 1.00 to 1.75), and mortality (hazard ratio, 1.27; 95% CI, 0.98 to 1.64). After adding depressive symptoms to the multivariable models, the relationship further declined toward the null, particularly for rehospitalization (hazard ratio, 1.14; 95% CI, 0.98 to 1.34) and angina (odds ratio, 1.22; 95% CI, 0.91 to 1.63), whereas there was little change in the estimate for mortality (hazard ratio, 1.24; 95% CI, 0.95 to 1.62). Depressive symptoms were significantly associated with each of the study outcomes with a similar magnitude of effect in both women and men.
A higher prevalence of depressive symptoms in women modestly contributes to their higher rates of rehospitalization and angina compared with men but not mortality after MI. Our results support the recent recommendations of improving recognition of depressive symptoms after MI.
在许多研究中，与男性相比，女性心肌梗死（MI）后的预后情况不明原因地更差。抑郁症状可预测MI后的不良预后，且在女性中比男性更为普遍。我们研究了抑郁症状是否导致女性MI后预后更差。
在一项前瞻性多中心研究（PREMIER）中，纳入了2411例MI患者（807例女性）。使用患者健康问卷评估抑郁症状。结局包括1年再住院率、使用西雅图心绞痛问卷评估的心绞痛情况以及2年死亡率。采用多变量分析评估性别与这些结局之间的关联，并对临床特征进行校正。将抑郁症状评分纳入模型，以评估其是否减弱了性别与结局之间的关联。与男性相比，女性抑郁症状更为普遍（29%对18.8%，P<0.001）。在对人口统计学因素、合并症和MI严重程度进行校正后，女性再住院风险略高（风险比，1.20；95%CI，1.04至1.40）、心绞痛风险（优势比，1.32；95%CI，1.00至1.75）和死亡率（风险比，1.27；95%CI，0.98至1.64）。在多变量模型中加入抑郁症状后，这种关系进一步向无效方向下降，尤其是再住院（风险比，1.14；95%CI，0.98至1.34）和心绞痛（优势比，1.22；95%CI，0.91至1.63），而死亡率估计值变化不大（风险比，1.24；95%CI，0.95至1.62）。抑郁症状与每项研究结局均显著相关，在女性和男性中的效应大小相似。
与男性相比，女性中抑郁症状的较高患病率适度导致了她们较高的再住院率和心绞痛发生率，但对MI后的死亡率无影响。我们的结果支持了近期关于改善MI后抑郁症状识别的建议。
