Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Int J Cardiol. 2023 Jun 15;381:120-127. doi: 10.1016/j.ijcard.2023.04.023. Epub 2023 Apr 18.
Depression and anxiety are risk factors for patients with myocardial infarction (MI). However, the association of a previous psychiatric diagnosis of anxiety or depression, or only such self-reported symptoms, with cardiovascular outcomes and mortality post-MI has not been previously examined in the same nationwide cohort.
We linked demographic, socioeconomic and clinical data from four nationwide Swedish registries for patients enrolled in cardiac rehabilitation (CR) after first-time MI (2006-2015, N = 45,096). After multiple imputation, we applied Cox regression to estimate the post-MI outcome risk for patients with a previous psychiatric diagnosis of anxiety/depression (Diagnosis), patients with no formal diagnosis but self-reported symptoms of anxiety/depression (Symptoms), versus patients with neither Diagnosis nor Symptoms (Reference).
During one-year follow-up, fully adjusted models showed that patients with Diagnosis had a higher risk (hazard ratio [95%CI]) of all-cause mortality (1.86 [1.36, 2.53]), reinfarction (1.14 [1.06, 1.22]), their composite (1.15 [1.07, 1.23]), and an extended cardiovascular composite (1.19 [1.12, 1.26]), versus Reference, even though 77% reported no symptoms at the time of MI. In patients with Symptoms, estimates were also elevated yet somewhat attenuated compared to Reference. Findings were overall robust across multiple sensitivity analyses.
Both a previous diagnosis, and present self-reported symptoms of anxiety or depression are associated with an increased risk of death and recurrent cardiovascular events in adults with first-time MI. Only screening for present symptoms is inadequate for assessing this excessive risk. Assessment of both psychiatric history and self-reported symptoms seems warranted for these patients.
抑郁和焦虑是心肌梗死（MI）患者的风险因素。然而，以前的焦虑或抑郁精神科诊断，或仅存在这种自我报告的症状，与 MI 后心血管结局和死亡率的关联，以前尚未在同一全国性队列中进行过检查。
我们将来自瑞典四个全国性的心脏康复（CR）注册中心的人口统计学、社会经济学和临床数据与首次 MI 后入组的患者（2006-2015 年，n=45096）进行了链接。经过多次插补后，我们应用 Cox 回归估计了以前有焦虑/抑郁精神科诊断（诊断）、无正式诊断但有焦虑/抑郁自我报告症状（症状）的患者，以及既无诊断也无症状的患者（参考）的 MI 后结局风险。
在一年的随访期间，完全调整后的模型显示，有诊断的患者全因死亡率（1.86 [1.36，2.53]）、再梗死（1.14 [1.06，1.22]）、复合终点（1.15 [1.07，1.23]）和扩展的心血管复合终点（1.19 [1.12，1.26]）的风险均较高，与参考组相比，尽管 77%的患者在 MI 时没有症状。在有症状的患者中，与参考组相比，估计值也升高，但有所减弱。在多项敏感性分析中，这些发现总体上都是稳健的。
以前的诊断和现在的焦虑或抑郁自我报告症状均与首次 MI 成年患者的死亡和复发性心血管事件风险增加相关。仅筛查目前的症状不足以评估这种过高的风险。对于这些患者，评估精神病史和自我报告的症状似乎是合理的。
