Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen / University of Groningen, Groningen, The Netherlands.
Int J Cardiol. 2013 Sep 10;167(6):2533-8. doi: 10.1016/j.ijcard.2012.06.042. Epub 2012 Jun 27.
The presence of depressive symptoms after myocardial infarction (MI) is associated with worsened cardiovascular (CV) prognosis. To date, it remains unclear to what extent the relationship between post-MI depression and prognosis is confounded by factors related to prognosis. We assessed the relationship between depression and prognosis while adjusting for a well validated risk score for mortality after a MI.
Data of 494 MI patients were derived from the Depression after Myocardial Infarction study (DepreMI). Scores on the Beck Depression Inventory (BDI) (cut-off ≥ 10) were used to relate depressive symptoms (divided in somatic/affective and cognitive/affective symptoms) to the Global Registry of Acute Coronary Events (GRACE) risk score, using Pearson correlations. Cox regression analysis was performed to investigate the predictive value of depressive symptoms for prognosis after adjusting for GRACE score.
Overall, depressive symptoms were significantly correlated with GRACE score (r=0.12, p=0.008). Specifically, somatic/affective symptoms were positively correlated (r=0.23, p<0.001), whereas cognitive/affective symptoms tended to be negatively correlated (r=-0.08, p=0.097) with GRACE score. Adjusting for GRACE score did not affect the HR for recurrent CV events associated with total BDI- score (adjusted hazard ratio (HR) per point increase in BDI score 1.05 p=0.002 95% CI 1.02-1.08 n=463). Furthermore GRACE score attenuated the HR associated with 1 SD increase in somatic/affective depressive symptoms from 1.44 (1.20-1.72) to 1.31 (1.08-1.58).
GRACE score was positively associated with somatic/affective depressive symptoms. GRACE score explained only partly the association between (somatic/affective) depressive symptoms and CV prognosis.
心肌梗死后（MI）出现抑郁症状与心血管（CV）预后恶化相关。迄今为止，尚不清楚 MI 后抑郁与预后之间的关系在多大程度上受到与预后相关的因素的影响。我们评估了抑郁与预后之间的关系，同时调整了 MI 后死亡率的验证良好的风险评分。
DepreMI 研究中的 494 名 MI 患者的数据用于本研究。采用贝克抑郁量表（BDI）（临界值≥10）的评分，将抑郁症状（分为躯体/情感和认知/情感症状）与全球急性冠状动脉事件注册（GRACE）风险评分相关联，采用 Pearson 相关分析。进行 Cox 回归分析，以调查调整 GRACE 评分后抑郁症状对预后的预测价值。
总的来说，抑郁症状与 GRACE 评分显著相关（r=0.12，p=0.008）。具体而言，躯体/情感症状呈正相关（r=0.23，p<0.001），而认知/情感症状与 GRACE 评分呈负相关（r=-0.08，p=0.097）。调整 GRACE 评分后，对与总 BDI 评分相关的复发性 CV 事件的 HR 没有影响（BDI 评分每增加 1 分，HR 增加 1.05，p=0.002，95%CI 1.02-1.08，n=463）。此外，GRACE 评分使与 1 SD 躯体/情感抑郁症状增加相关的 HR 从 1.44（1.20-1.72）降低到 1.31（1.08-1.58）。
GRACE 评分与躯体/情感抑郁症状呈正相关。GRACE 评分仅部分解释了（躯体/情感）抑郁症状与 CV 预后之间的关系。
