Department of Medicine, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. Email:
Department of Public Health, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Cardiovasc J Afr. 2021;32(2):70-77. doi: 10.5830/CVJA-2020-030. Epub 2021 Mar 26.
Patients with coronary artery disease (CAD) are prone to depression, and its presence is associated with poor adverse cardiac outcomes. Although lifestyle modification (LSM) has been shown to be beneficial in managing depression in patients with CAD, it is not known whether the mode of cardiac intervention [(coronary artery bypass graft surgery (CABG) versus percutaneous coronary intervention (PCI)] influences the outcome.
We examined the prevalence of depression among myocardial infarction (MI) patients after revascularisation and compared the effect of LSM on incidence of depression in patients who underwent CABG versus PCI.
We evaluated the risk-factor profile, depression characteristics and lifestyle changes of 100 consecutive participants undergoing coronary revascularisation over a 15-month period (January 2017 to May 2018). The Beck depression inventory II (BDI-II) was used to assess depression and the Goldin leisure-time exercise (GLTE) questionnaire to assess physical activity (PA).
One hundred patients were recruited (mean age: males 60.73 ± 4.52 years, females 60.29 ± 3.64 years) but five dropped out, leaving 95 patients for complete analysis. Most of the patients were low-income earners [53 (53.0%)], and 21 (21.0%) had tertiary-level education. The majority had multiple CAD risk factors and co-morbidities (79.0%). Prior to the LSM programme, 51 patients (51.0%) had depression and depressive traits [CABG 34 (66.7%) vs PCI 17 (33.3%), = 0.047]. After LSM the overall prevalence of depression and depressive traits fell to 33 patients (34.7%) [PCI eight (23.0%) vs CABG 25 patients (72.0%), = 0.001]. The mean depression scores also fell from 21.11 ± 7.75 to 14.98 ± 9.61 ( = 0.002). At baseline, PCI patients were more physically active compared to CABG patients [three (60.0%) vs two patients (40.0%), respectively, = 0.715]. After LSM, more PCI patients undertook PA compared to CABG subjects [24 (60.0%) vs 14 patients (35.0%), respectively, = 0.012]. The PA score was also higher among the PCI group compared to the CABG group [14.16 ± 9.73 vs 9.40 ± 10.94, respectively, = 0.024]. In fully compliant subjects, the benefit derived was similar regardless of the mode of intervention [OR 1.10, 95% CI: 0.78-4.23, = 0.191]. Using multivariate analysis, the main predictors of depression and depressive traits were female gender (OR 3.29, 95% CI: 1.51-11.03, = 0.008), CABG (OR 1.86, 95% CI: 1.68-5.77, = 0.003), heart failure (OR 2.65, 95% CI: 5.87-13.62, = 0.000), kidney failure (OR 1.41, 95% CI: 1.30-5.23, = 0.041), atrial fibrillation (OR 1.60, 95% CI: 1.40-4.77, p = 0.023), low PA (OR 1.97, 95%, CI: 11.23-33.20, = 0.000), previous history of depression (OR 8.99, 95% CI: 1.90-7.89, = 0.002) and low income (OR 2.21, 95% CI: 1.40-2.85, = 0.000).
Depression and depressive traits are common among subjects undergoing coronary revascularisation, more so among CABG than PCI participants. LSM reduced the prevalence of depression and depressive traits, with fully compliant CABG versus PCI groups deriving nearly the same benefits from the LSM regime. No significant reduction in incidence of depression was recorded among LSM partly compliant patients. This study suggests that failure to implement lifestyle changes and engage in PA are major barriers to managing depression after coronary revascularisation.
患有冠状动脉疾病（CAD）的患者容易抑郁，其存在与不良心脏预后相关。尽管生活方式改变（LSM）已被证明对 CAD 患者的抑郁管理有益，但尚不清楚心脏介入治疗的方式（冠状动脉旁路移植术（CABG）与经皮冠状动脉介入治疗（PCI））是否会影响结果。
我们检查了再血管化后心肌梗死（MI）患者中抑郁的患病率，并比较了 LSM 对 CABG 与 PCI 患者发生抑郁的影响。
我们评估了 100 名连续接受冠状动脉血运重建的参与者的风险因素谱、抑郁特征和生活方式变化，时间跨度为 15 个月（2017 年 1 月至 2018 年 5 月）。使用贝克抑郁量表 II（BDI-II）评估抑郁，使用戈尔丁闲暇时间运动（GLTE）问卷评估体力活动（PA）。
共招募了 100 名患者（男性平均年龄：60.73 ± 4.52 岁，女性 60.29 ± 3.64 岁），但有 5 人中途退出，95 人完成了完整分析。大多数患者为低收入者（53 名，占 53.0%），21 名（21.0%）具有三级教育水平。大多数患者存在多种 CAD 风险因素和合并症（79.0%）。在 LSM 计划之前，51 名患者（51.0%）存在抑郁和抑郁特质[CABG 34 名（66.7%）与 PCI 17 名（33.3%），= 0.047]。在 LSM 之后，总体抑郁和抑郁特质的患病率下降至 33 名患者（34.7%）[PCI 8 名（23.0%）与 CABG 25 名患者（72.0%），= 0.001]。平均抑郁评分也从 21.11 ± 7.75 降至 14.98 ± 9.61（= 0.002）。在基线时，与 CABG 患者相比，PCI 患者的体力活动更多[分别为 60.0%和 40.0%，= 0.715]。在 LSM 之后，与 CABG 患者相比，更多的 PCI 患者进行了 PA[分别为 60.0%和 35.0%，= 0.012]。与 CABG 组相比，PCI 组的 PA 评分也更高[分别为 14.16 ± 9.73 和 9.40 ± 10.94，= 0.024]。在完全依从的患者中，无论干预方式如何，获益都相似[比值比 1.10，95%置信区间：0.78-4.23，= 0.191]。使用多变量分析，抑郁和抑郁特质的主要预测因素是女性（比值比 3.29，95%置信区间：1.51-11.03，= 0.008）、CABG（比值比 1.86，95%置信区间：1.68-5.77，= 0.003）、心力衰竭（比值比 2.65，95%置信区间：5.87-13.62，= 0.000）、肾衰竭（比值比 1.41，95%置信区间：1.30-5.23，= 0.041）、心房颤动（比值比 1.60，95%置信区间：1.40-4.77，= 0.023）、低 PA（比值比 1.97，95%置信区间：11.23-33.20，= 0.000）、既往抑郁史（比值比 8.99，95%置信区间：1.90-7.89，= 0.002）和低收入（比值比 2.21，95%置信区间：1.40-2.85，= 0.000）。
抑郁和抑郁特质在接受冠状动脉血运重建的患者中很常见，CABG 患者比 PCI 患者更为常见。LSM 降低了抑郁和抑郁特质的患病率，完全依从的 CABG 与 PCI 组从 LSM 方案中获得了几乎相同的益处。在部分依从的 LSM 患者中，没有显著降低抑郁的发生率。本研究表明，未能实施生活方式改变和进行体力活动是冠状动脉血运重建后管理抑郁的主要障碍。
