AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
Eur J Intern Med. 2019 Mar;61:75-80. doi: 10.1016/j.ejim.2018.12.003. Epub 2019 Jan 28.
To assess the impact of antidepressant (AD) prescription at discharge on 1-year outcome of patients presenting with acute myocardial infarction (AMI) in Switzerland.
We used data from the AMIS Plus registry including patients admitted between March 2005 and August 2016 with AMI to a Swiss hospital who were followed up by telephone, 12 months after discharge. We compared patients who received AD medication at discharge with those who did not, with regard to baseline characteristics and outcomes in 1-year follow-ups using logistic regression. Outcome endpoints included mortality, re-hospitalisation, cerebrovascular events, re-infarction, percutaneous coronary intervention (PCI), coronary artery bypass graft as well as pacemaker and/or cardioverter-defibrillator implantations. Additionally, work and daily life conditions were compared between the groups.
Among 8911 AMI patients, 565 (6.3%) received AD at discharge. These patients were predominantly female, older, experienced more often non-ST-segment elevation myocardial infarction, were in higher Killip classes, and had more frequently hypertension, diabetes, dyslipidaemia, obesity and comorbidities. They underwent less frequently PCI, and stayed in hospital longer. The AD-receiving group had higher crude all-cause mortality at 1-year follow-up than the non-receiving group (7.4% vs 3.4%; p < .001) and AD prescription was an independent predictor for mortality (OR 1.67; CI: 1.17 to 2.40).
AD medication at discharge was associated with poorer prognosis in AMI patients at 1-year follow-up. However, this study has limited data on depression diagnosis and drug classes. Further research is needed to pinpoint the causes and underlying pathomechanisms for the higher mortality observed in this patient group.
评估在瑞士，急性心肌梗死（AMI）患者出院时开具抗抑郁药（AD）对其 1 年结局的影响。
我们使用了 AMIS Plus 注册研究的数据，该研究纳入了 2005 年 3 月至 2016 年 8 月期间因 AMI 入住瑞士医院的患者，通过电话对其进行随访，随访时间为出院后 12 个月。我们使用 logistic 回归比较了出院时接受 AD 药物治疗与未接受 AD 药物治疗的患者在 1 年随访中的基线特征和结局。结局终点包括死亡率、再入院、脑血管事件、再梗死、经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术以及起搏器和/或除颤器植入。此外，我们还比较了两组患者的工作和日常生活状况。
在 8911 例 AMI 患者中，565 例（6.3%）出院时接受了 AD。这些患者主要为女性，年龄较大，更常发生非 ST 段抬高型心肌梗死，心功能Killip 分级更高，且更常患有高血压、糖尿病、血脂异常、肥胖和合并症。他们较少接受 PCI，住院时间更长。AD 治疗组在 1 年随访时的全因死亡率高于未治疗组（7.4%比 3.4%；p<0.001），且 AD 处方是死亡率的独立预测因素（OR 1.67；95%CI：1.17 至 2.40）。
出院时开具 AD 药物与 AMI 患者 1 年随访时的预后较差相关。然而，本研究关于抑郁诊断和药物种类的资料有限。需要进一步研究以确定观察到的该患者组死亡率较高的原因和潜在病理机制。
