Hayek Salim S, Ko Yi-An, Awad Mosaab, Del Mar Soto Andrea, Ahmed Hina, Patel Keyur, Yuan Michael, Maddox Spencer, Gray Brandon, Hajjari Jamal, Sperling Laurence, Shah Amit, Vaccarino Viola, Quyyumi Arshed A
Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
Int J Cardiol. 2017 Mar 1;230:420-426. doi: 10.1016/j.ijcard.2016.12.091. Epub 2016 Dec 23.
Depression is common in patients with coronary artery disease (CAD) and is associated with more frequent chest pain. It is however unclear whether this is due to differences in underlying CAD severity. We sought to determine [1] whether depressive symptoms are associated with chest pain independently of CAD severity, [2] whether improvement in depressive symptoms over time is associated with improvement in chest pain and [3] whether the impact of revascularization on chest pain differs between patients with and without depression.
5158 patients (mean age 63±12years, 65% male, 20% African American) undergoing cardiac catheterization completed the Seattle Angina Questionnaire (SAQ) and Patient Health Questionnaire-8 (PHQ-8) to assess angina severity and screen for depression, respectively, both at baseline and between 6 and 24months of follow-up. We found significant correlations between PHQ-8 scores and angina frequency (SAQ-AF, r=-0.28), physical limitation (SAQ-PL, r=-0.32) and disease perception (SAQ-DS r=-0.37, all P<0.001), which remained significant after adjustment for clinical characteristics, CAD severity, and anti-depressant use. Improvement in depressive symptoms at follow-up was associated with improvement in angina subscales (SAQ-AF β 1.34, P<0.001), SAQ-PL β 1.85, P<0.001), and SAQ-DS (β 2.12, P<0.001), independently of CAD severity or revascularization. Patients with depression who underwent revascularization had less improvement in chest pain frequency than those without depressive symptoms.
Depression is associated with angina, independently of CAD severity. Patients with depression may not derive as adequate symptomatic benefit from revascularization as those without. Whether treatment of underlying depression improves chest pain needs to be further studied.
抑郁症在冠状动脉疾病（CAD）患者中很常见，且与更频繁的胸痛相关。然而，目前尚不清楚这是否归因于潜在CAD严重程度的差异。我们试图确定：[1]抑郁症状是否独立于CAD严重程度与胸痛相关；[2]随着时间推移抑郁症状的改善是否与胸痛的改善相关；[3]血管重建对胸痛的影响在有抑郁症和无抑郁症的患者之间是否存在差异。
5158例接受心脏导管插入术的患者（平均年龄63±12岁，65%为男性，20%为非裔美国人）在基线时以及随访6至24个月期间分别完成了西雅图心绞痛问卷（SAQ）和患者健康问卷-8（PHQ-8），以评估心绞痛严重程度和筛查抑郁症。我们发现PHQ-8评分与心绞痛频率（SAQ-AF，r=-0.28）、身体限制（SAQ-PL，r=-0.32）和疾病认知（SAQ-DS，r=-0.37，所有P<0.001）之间存在显著相关性，在调整临床特征、CAD严重程度和抗抑郁药使用后这些相关性仍然显著。随访时抑郁症状的改善与心绞痛子量表（SAQ-AF β 1.34，P<0.001）、SAQ-PL（β 1.85，P<0.001）和SAQ-DS（β 2.12，P<0.001）的改善相关，且独立于CAD严重程度或血管重建。接受血管重建的抑郁症患者在胸痛频率方面的改善不如无抑郁症状的患者。
抑郁症与心绞痛相关，独立于CAD严重程度。抑郁症患者可能无法像无抑郁症患者那样从血管重建中获得足够的症状改善。潜在抑郁症的治疗是否能改善胸痛需要进一步研究。
