Stenman Malin, Holzmann Martin J, Sartipy Ulrik
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden.
Int J Cardiol Heart Vessel. 2014 Mar 6;3:37-42. doi: 10.1016/j.ijchv.2014.02.005. eCollection 2014 Jun.
We hypothesized that depressed patients would have lower use of guideline-directed medical therapy for secondary prevention of cardiovascular events following coronary artery bypass grafting (CABG).
We included all patients who underwent primary isolated CABG in Sweden between 2006 and 2008. We cross-linked individual level data from national Swedish registers. Preoperative depression was defined as at least one antidepressant prescription dispensed before surgery. We defined medication use as at least two dispensed prescriptions in each medication class (antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blocker (ARB), and statins) within a rolling 12 month period. We calculated adjusted risk ratios (RR) for the use of each medication class, and for all four classes, after one and four years, respectively.
During the first year after CABG, 93% of all patients (n = 10,586) had at least two dispensed prescriptions for an antiplatelet agent, 68% for an ACEI/ARB, 91% for a beta-blocker, and 92% for a statin. 57% had prescriptions for all four medication classes. After four years (n = 4034), 44% had filled prescriptions for all four medication classes. Preoperative depression was not significantly associated with a lower use of all four medication classes after one year (RR 0.98, 95% confidence interval (CI) 0.93-1.03) or after four years (RR 0.97, 95% CI 0.86-1.09).
Preoperative depression was not associated with lower use of guideline-directed medical therapy for secondary prevention after CABG. These findings suggest that the observed higher mortality following CABG among depressed patients is not explained by inadequate secondary prevention medication.
我们假设，冠状动脉旁路移植术（CABG）后，抑郁症患者接受心血管事件二级预防的指南指导药物治疗的比例较低。
我们纳入了2006年至2008年期间在瑞典接受初次单纯CABG的所有患者。我们将瑞典国家登记册中的个体层面数据进行了交叉关联。术前抑郁症定义为手术前至少开具过一次抗抑郁药处方。我们将药物使用定义为在连续12个月内，每个药物类别（抗血小板药物、β受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）/血管紧张素II受体阻滞剂（ARB）和他汀类药物）至少有两次配药处方。我们分别计算了术后1年和4年时，每个药物类别以及所有四类药物使用的调整风险比（RR）。
CABG后的第一年，所有患者（n = 10,586）中93%至少有两次抗血小板药物的配药处方，68%有ACEI/ARB的配药处方，91%有β受体阻滞剂的配药处方，92%有他汀类药物的配药处方。57%的患者所有四类药物都有处方。4年后（n = 4034），44%的患者所有四类药物都有配药处方。术前抑郁症与术后1年（RR 0.98，95%置信区间（CI）0.93 - 1.03）或4年后（RR 0.97，95% CI 0.86 - 1.09）所有四类药物使用比例较低无显著关联。
术前抑郁症与CABG后二级预防的指南指导药物治疗使用比例较低无关。这些发现表明，抑郁症患者CABG后观察到的较高死亡率不能用二级预防药物不足来解释。
