Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA.
Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
Ann Behav Med. 2023 Feb 4;57(2):155-164. doi: 10.1093/abm/kaab092.
Depression after acute coronary syndrome (ACS) is common and increases risks of adverse outcomes, but it remains unclear which depression features are most associated with major adverse cardiac events (MACE) and all-cause mortality (ACM).
To examine whether a subtype of depression characterized by anhedonia and major depressive disorder (MDD) predicts 1-year MACE/ACM occurrence in ACS patients compared to no MDD history. We also consider other depression features in the literature as predictors.
Patients (N = 1,087) presenting to a hospital with ACS completed a self-report measure of current depressive symptoms in-hospital and a diagnostic interview assessing MDD within 1 week post-hospitalization. MACE/ACM events were assessed at 1-, 6-, and 12-month follow-ups. Cox regression models were used to examine the association of the anhedonic depression subtype and MDD without anhedonia with time to MACE/ACM, adjusting for sociodemographic and clinical covariates.
There were 142 MACE/ACM events over the 12-month follow-up. The 1-year MACE/ACM in patients with anhedonic depression, compared to those with no MDD, was somewhat higher in an age-adjusted model (hazard ratio [HR] = 1.63, p = .08), but was not significant after further covariate adjustment (HR = 1.24, p = .47). Of the additional depression features, moderate-to-severe self-reported depressive symptoms significantly predicted the risk of MACE/ACM, even in covariate-adjusted models (HR = 1.72, p = .04), but the continuous measure of self-reported depressive symptoms did not.
The anhedonic depression subtype did not uniquely predict MACE/ACM as hypothesized. Moderate-to-severe levels of total self-reported depressive symptoms, however, may be associated with increased MACE/ACM risk, even after accounting for potential sociodemographic and clinical confounders.
急性冠脉综合征（ACS）后抑郁较为常见，会增加不良预后的风险，但目前尚不清楚哪种抑郁特征与主要不良心脏事件（MACE）和全因死亡率（ACM）的相关性最大。
本研究旨在探究以快感缺失和重性抑郁障碍（MDD）为特征的抑郁亚型是否比无 MDD 病史更能预测 ACS 患者 1 年内发生 MACE/ACM。我们还考虑了文献中的其他抑郁特征作为预测因子。
共 1087 名 ACS 患者在住院期间完成了一项当前抑郁症状的自评量表，在住院后 1 周内完成了一项评估 MDD 的诊断性访谈。在 1、6 和 12 个月的随访时评估 MACE/ACM 事件。使用 Cox 回归模型，在校正了社会人口统计学和临床协变量后，分析快感缺失型抑郁亚型和无快感缺失的 MDD 与 MACE/ACM 时间的相关性。
在 12 个月的随访中，有 142 例发生 MACE/ACM。与无 MDD 的患者相比，在年龄调整模型中，快感缺失型抑郁患者 1 年时的 MACE/ACM 发生率略高（风险比[HR] = 1.63，p =.08），但在进一步调整协变量后无统计学意义（HR = 1.24，p =.47）。在其他抑郁特征中，中度至重度自我报告的抑郁症状即使在调整协变量的模型中也显著预测了 MACE/ACM 的风险（HR = 1.72，p =.04），但自我报告的抑郁症状的连续测量值则没有。
与假设相反，快感缺失型抑郁亚型并不能单独预测 MACE/ACM。然而，中度至重度的自我报告抑郁症状水平可能与 MACE/ACM 风险增加相关，即使考虑到潜在的社会人口统计学和临床混杂因素也是如此。
