Interdisciplinary Centre for Psychiatric Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands.
Br J Psychiatry. 2013 Aug;203(2):90-102. doi: 10.1192/bjp.bp.112.111195.
The association between depression after myocardial infarction and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity.
To combine original data from studies on the association between post-infarction depression and prognosis into one database, and to investigate to what extent such depression predicts prognosis independently of disease severity.
An individual patient data meta-analysis of studies was conducted using multilevel, multivariable Cox regression analyses.
Sixteen studies participated, creating a database of 10 175 post-infarction cases. Hazard ratios for post-infarction depression were 1.32 (95% CI 1.26-1.38, P<0.001) for all-cause mortality and 1.19 (95% CI 1.14-1.24, P<0.001) for cardiovascular events. Hazard ratios adjusted for disease severity were attenuated by 28% and 25% respectively.
The association between depression following myocardial infarction and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score.
心肌梗死后抑郁与死亡率和心脏发病率增加之间的关联可能是由于心脏病的严重程度。
将心肌梗死后抑郁与预后之间关联的原始研究数据合并到一个数据库中，并探讨这种抑郁在多大程度上独立于疾病严重程度预测预后。
采用多级、多变量 Cox 回归分析对研究进行个体患者数据荟萃分析。
16 项研究参与，创建了 10175 例心肌梗死后病例的数据库。心肌梗死后抑郁的全因死亡率的危险比为 1.32（95%CI 1.26-1.38，P<0.001），心血管事件的危险比为 1.19（95%CI 1.14-1.24，P<0.001）。分别调整疾病严重程度后，危险比分别减弱了 28%和 25%。
心肌梗死后抑郁与预后之间的关联在调整心脏疾病严重程度后减弱。尽管如此，抑郁仍然与预后独立相关，抑郁 z 评分每增加一个标准差，全因死亡率的风险增加 22%，心血管事件的风险增加 13%。
