急性心肌梗死后的抑郁症治疗与1年死亡率：来自TRIUMPH注册研究（急性心肌梗死患者健康状况潜在差异的转化研究）的见解
Depression Treatment and 1-Year Mortality After Acute Myocardial Infarction: Insights From the TRIUMPH Registry (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status).
作者信息
Smolderen Kim G, Buchanan Donna M, Gosch Kensey, Whooley Mary, Chan Paul S, Vaccarino Viola, Parashar Susmita, Shah Amit J, Ho P Michael, Spertus John A
机构信息
From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.).
出版信息
Circulation. 2017 May 2;135(18):1681-1689. doi: 10.1161/CIRCULATIONAHA.116.025140. Epub 2017 Feb 16.
BACKGROUND
Depression among patients with acute myocardial infarction (AMI) is prevalent and associated with an adverse quality of life and prognosis. Despite recommendations from some national organizations to screen for depression, it is unclear whether treatment of depression in patients with AMI is associated with better outcomes. We aimed to determine whether the prognosis of patients with treated versus untreated depression differs.
METHODS
The TRIUMPH study (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status) is an observational multicenter cohort study that enrolled 4062 patients aged ≥18 years with AMI between April 11, 2005, and December 31, 2008, from 24 US hospitals. Research coordinators administered the Patient Health Questionnaire-9 (PHQ-9) during the index AMI admission. Depression was defined by a PHQ-9 score of ≥10. Depression was categorized as treated if there was documentation of a discharge diagnosis, medication prescribed for depression, or referral for counseling, and as untreated if none of these 3 criteria was documented in the medical records despite a PHQ score ≥10. One-year mortality was compared between patients with AMI having: (1) no depression (PHQ-9<10; reference); (2) treated depression; and (3) untreated depression adjusting for demographics, AMI severity, and clinical factors.
RESULTS
Overall, 759 (18.7%) patients met PHQ-9 criteria for depression and 231 (30.4%) were treated. In comparison with 3303 patients without depression, the 231 patients with treated depression had 1-year mortality rates that were not different (6.1% versus 6.7%; adjusted hazard ratio, 1.12; 95% confidence interval, 0.63-1.99). In contrast, the 528 patients with untreated depression had higher 1-year mortality in comparison with patients without depression (10.8% versus 6.1%; adjusted hazard ratio, 1.91; 95% confidence interval, 1.39-2.62).
CONCLUSIONS
Although depression in patients with AMI is associated with increased long-term mortality, this association may be confined to patients with untreated depression.
背景
急性心肌梗死（AMI）患者中抑郁症很常见，且与生活质量差和预后不良相关。尽管一些国家组织建议对抑郁症进行筛查，但尚不清楚治疗AMI患者的抑郁症是否能带来更好的结果。我们旨在确定接受治疗与未接受治疗的抑郁症患者的预后是否存在差异。
方法
TRIUMPH研究（急性心肌梗死患者健康状况潜在差异的转化研究）是一项观察性多中心队列研究，于2005年4月11日至2008年12月31日期间，从美国24家医院纳入了4062例年龄≥18岁的AMI患者。研究协调员在首次AMI入院期间进行患者健康问卷-9（PHQ-9）评估。PHQ-9评分≥10定义为抑郁症。如果有出院诊断记录、开具治疗抑郁症的药物或转介咨询，则抑郁症分类为接受治疗；如果尽管PHQ评分≥10，但病历中未记录这三项标准中的任何一项，则分类为未接受治疗。比较患有以下情况的AMI患者的1年死亡率：（1）无抑郁症（PHQ-9<10；参照组）；（2）接受治疗的抑郁症；（3）未接受治疗的抑郁症，并对人口统计学、AMI严重程度和临床因素进行校正。
结果
总体而言，759例（18.7%）患者符合PHQ-9抑郁症标准，其中231例（30.4%）接受了治疗。与3303例无抑郁症患者相比，231例接受治疗的抑郁症患者的1年死亡率无差异（6.1%对6.7%；校正风险比，1.12；95%置信区间，0.63-1.99）。相比之下，528例未接受治疗的抑郁症患者的1年死亡率高于无抑郁症患者（10.8%对6.1%；校正风险比，1.91；95%置信区间，1.39-2.62）。
结论
尽管AMI患者的抑郁症与长期死亡率增加有关，但这种关联可能仅限于未接受治疗的抑郁症患者。
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