Australian Centre for Heart Health, Melbourne, Vic, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
Australian Centre for Heart Health, Melbourne, Vic, Australia.
Heart Lung Circ. 2019 Dec;28(12):1812-1818. doi: 10.1016/j.hlc.2018.11.013. Epub 2018 Dec 5.
Past studies have found that depression is an independent predictor of death in patients after acute myocardial infarction (AMI). Our aim was to investigate whether the adverse effect upon mortality of depression, including mild levels, persisted up to 25 years.
We used an historical design to study patients who had been consecutively admitted to hospital after transmural AMI during the 1980s and enrolled in an exercise training trial. The Beck Depression Inventory (BDI) was administered to 188 patients in the third week after hospital admission. Scores were trichotomised and classified as low (0-5), mild (6-9) or moderate to severe (≥10) depression. The Australian National Death Index was used to determine mortality status. Cox proportional-hazards modelling was undertaken to determine the relationship between the trichotomised BDI-I scores and all-cause mortality over five time periods up to 25 years.
The mean age of patients was 54.15 years. One hundred fourteen (114) (60.4%) had low or no depression, 47 (25.2%) mild depression and 27 (14.3%) moderate to severe depression. The mortality status of 185 (98.4%) patients was established. Depression was a significant predictor of death, independently of age and severity of myocardial infarction, at 5, 10 and 15 years but not at 20 or 25 years. Patients with mild depression had greater mortality than those with low or moderate to severe depression.
Early identification of depression, including milder levels, is important since patients remain at increased risk for many years. They require ongoing monitoring and appropriate treatment.
过去的研究发现，抑郁是急性心肌梗死（AMI）后患者死亡的独立预测因素。我们的目的是研究抑郁（包括轻度水平）对死亡率的不良影响是否持续长达 25 年。
我们使用历史设计研究了在 20 世纪 80 年代连续因透壁性 AMI 住院并参加运动训练试验的患者。在住院后第三周，对 188 名患者进行了贝克抑郁量表（BDI）评估。评分分为三部分，分为低（0-5）、轻度（6-9）或中重度（≥10）抑郁。使用澳大利亚国家死亡索引确定死亡状态。采用 Cox 比例风险模型确定三分类 BDI-I 评分与五个时间段内全因死亡率的关系，最长可达 25 年。
患者的平均年龄为 54.15 岁。114 名（60.4%）患者无或轻度抑郁，47 名（25.2%）患者轻度抑郁，27 名（14.3%）患者中重度抑郁。185 名（98.4%）患者的死亡状态得到确定。抑郁是死亡的独立预测因素，与年龄和心肌梗死严重程度无关，在 5、10 和 15 年时，但在 20 或 25 年时则无关。轻度抑郁患者的死亡率高于中重度抑郁患者。
早期识别抑郁，包括轻度抑郁，非常重要，因为患者在多年内仍面临更高的风险。他们需要持续监测和适当的治疗。
