Department of Liaison Psychiatry, Leicestershire Partnership Trust and Department of Cancer Studies and Molecular Medicine, Leicester Royal Infirmary, Leicester, UK.
Br J Psychiatry. 2011 Jun;198(6):434-41. doi: 10.1192/bjp.bp.109.076950.
High levels of comorbid physical illness and excess mortality rates have been previously documented in people with severe mental illness, but outcomes following myocardial infarction and other acute coronary syndromes are less clear.
To examine inequalities in the provision of invasive coronary procedures (revascularisation, angiography, angioplasty and bypass grafting) and subsequent mortality in people with mental illness and in those with schizophrenia, compared with those without mental ill health.
Systematic search and random effects meta-analysis were used according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies of mental health and cardiovascular procedures following cardiac events were eligible but we required a minimum of three independent studies to warrant pooling by procedure type. We searched Medline/PubMed and EMBASE abstract databases and ScienceDirect, Ingenta Select, SpringerLink and Online Wiley Library full text databases.
We identified 22 analyses of possible inequalities in coronary procedures in those with defined mental disorder, of which 10 also reported results in schizophrenia or related psychosis. All studies following acute coronary syndrome originated in the USA. The total sample size was 825 754 individuals. Those with mental disorders received 0.86 (relative risk, RR: 95% CI 0.80-0.92, P<0.0001) of comparable procedures with significantly lower receipt of coronary artery bypass graft (CABG; RR = 0.85, 95% CI 0.72-1.00), cardiac catheterisation (RR = 0.85, 95% CI 0.76-0.95) and percutaneous transluminal coronary angioplasty or percutaneous coronary intervention (PTCA/PCI; RR = 0.87, 95% CI 0.72-1.05). People with a diagnosis of schizophrenia received only 0.53 (95% CI 0.44-0.64, P<0.0001) of the usual procedure rate with significantly lower receipt of CABG (RR = 0.69, 95% CI 0.55-0.85) and PTCA/PCI (RR = 0.50, 95% CI 0.34-0.75). We identified 6 related studies examining mortality following cardiac events: for those with mental illness there was a 1.11 relative risk of mortality up to 1 year (95% CI 1.00-1.24, P = 0.05) but there was insufficient evidence to examine mortality rates in schizophrenia alone.
Following cardiac events, individuals with mental illness experience a 14% lower rate of invasive coronary interventions (47% in the case of schizophrenia) and they have an 11% increased mortality rate. Further work is required to explore whether these factors are causally linked and whether improvements in medical care might improve survival in those with mental ill health.
先前的研究已经证实，严重精神疾病患者存在合并躯体疾病和死亡率过高的情况，但心肌梗死和其他急性冠脉综合征的预后情况尚不清楚。
本研究旨在比较精神疾病患者和精神分裂症患者与无精神健康问题者在接受侵入性冠状动脉手术（血运重建、血管造影、经皮冠状动脉介入治疗和旁路移植术）和随后的死亡率方面是否存在差异。
根据系统评价和荟萃分析的首选报告项目，采用系统搜索和随机效应荟萃分析。研究对象为心脏事件后接受心理健康和心血管手术的患者，但我们需要至少 3 项独立研究才能保证按手术类型进行汇总。我们检索了 Medline/PubMed 和 EMBASE 摘要数据库以及 ScienceDirect、Ingenta Select、SpringerLink 和 Online Wiley Library 全文数据库。
我们共发现 22 项关于明确精神障碍患者在冠状动脉手术方面可能存在不平等的分析，其中 10 项也报告了精神分裂症或相关精神病的结果。所有急性冠脉综合征后研究均来自美国。总样本量为 825754 人。患有精神疾病的患者接受了 0.86（相对风险，95%置信区间 0.80-0.92，P<0.0001）的类似手术，而冠状动脉旁路移植术（CABG；RR=0.85，95%置信区间 0.72-1.00）、心导管检查术（RR=0.85，95%置信区间 0.76-0.95）和经皮腔内冠状动脉成形术或经皮冠状动脉介入治疗（PTCA/PCI；RR=0.87，95%置信区间 0.72-1.05）的接受率明显更低。诊断为精神分裂症的患者仅接受了 0.53（95%置信区间 0.44-0.64，P<0.0001）的常规手术率，而 CABG（RR=0.69，95%置信区间 0.55-0.85）和 PTCA/PCI（RR=0.50，95%置信区间 0.34-0.75）的接受率明显更低。我们还发现了 6 项关于心脏事件后死亡率的相关研究：对于患有精神疾病的患者，在 1 年时死亡率的相对风险为 1.11（95%置信区间 1.00-1.24，P=0.05），但尚不足以评估精神分裂症患者的死亡率。
在发生心脏事件后，患有精神疾病的患者接受侵入性冠状动脉介入治疗的比例较低（精神分裂症患者为 47%），为 47%，而死亡率则增加了 11%。需要进一步研究以探讨这些因素是否存在因果关系，以及改善医疗护理是否可以提高精神健康不良患者的生存率。
