Harvard Medical School, Boston, MA, USA.
Harv Rev Psychiatry. 2013 Mar-Apr;21(2):59-69. doi: 10.1097/HRP.0b013e31828a3612.
After participating in this educational activity, the reader should be better able to measure the risk of depression before and after coronary artery bypass graft (CABG) surgery; examine the course of depression after CABG; and apply the results of the study to the treatment of patients.
Depression is highly comorbid with coronary artery disease. Clinicians face the question of whether patients' depressive symptoms will improve after coronary artery bypass graft surgery (CABG). The objective of this meta-analysis is to determine the course of depressive symptoms after CABG.
EMBASE, PubMed, and PsycINFO were searched for studies assessing depression before and after CABG. Meta-analyses were performed for depression at early (1-2 weeks), recovery (>2 weeks to 2 months), mid (>2 months to 6 months), and late (>6 months) postoperative time points. Heterogeneity and publication bias were analyzed.
Thirty-nine studies were included in the meta-analysis. Twelve reported dichotomous outcomes; 18 reported continuous outcomes; and 9 reported both. Risk of depression was increased early (relative risk [RR] = 1.27; 95% confidence interval [CI], 1.01-1.61). There was a significantly decreased risk of depression at recovery (RR = 0.78; 95% CI, 0.67-0.90), mid (RR = 0.64; 95% CI, 0.58-0.70), and late (RR = 0.68; 95% CI, 0.58-0.79) time points without heterogeneity. All studies reporting continuous depression scales had significant heterogeneity.
The risk of depression decreased post-CABG when depression was measured dichotomously. While depression improves overall and remits for some patients after CABG, the majority of patients will not experience remission of depression. Preoperative and postoperative depression monitoring is important.
参与本项教育活动后，读者应能够更好地评估冠状动脉旁路移植术（CABG）前后的抑郁风险；检查 CABG 后抑郁的病程；并将研究结果应用于患者的治疗。
抑郁与冠状动脉疾病高度共病。临床医生面临的问题是，患者的抑郁症状在冠状动脉旁路移植术（CABG）后是否会改善。本荟萃分析的目的是确定 CABG 后抑郁症状的病程。
检索 EMBASE、PubMed 和 PsycINFO，评估 CABG 前后的抑郁情况。对早期（1-2 周）、恢复期（>2 周至 2 个月）、中期（>2 个月至 6 个月）和晚期（>6 个月）术后时间点的抑郁进行荟萃分析。分析了异质性和发表偏倚。
共有 39 项研究纳入荟萃分析。12 项报告了二分类结局；18 项报告了连续结局；9 项报告了两者。早期（相对风险 [RR] = 1.27；95%置信区间 [CI]，1.01-1.61）时，抑郁风险增加。在恢复期（RR = 0.78；95% CI，0.67-0.90）、中期（RR = 0.64；95% CI，0.58-0.70）和晚期（RR = 0.68；95% CI，0.58-0.79）时间点，抑郁风险显著降低，无异质性。所有报告连续抑郁量表的研究均存在显著异质性。
当以二分法测量抑郁时，CABG 后抑郁的风险降低。虽然 CABG 后总体上抑郁会改善，并且一些患者的抑郁会缓解，但大多数患者不会缓解抑郁。术前和术后抑郁监测很重要。
