Neppala Sivaram, Chigurupati Himaja Dutt, Chauhan Shaylika, Chinthapalli Mrunal Teja, Desai Rupak
Department of Internal Medicine, University of Texas at San Antonio, San Antonio, TX 78249, United States.
Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ 07102, United States.
World J Cardiol. 2024 Jul 26;16(7):412-421. doi: 10.4330/wjc.v16.i7.412.
Type 2 myocardial infarction (T2MI) is an ischemic myocardial injury in the context of oxygen supply/demand mismatch in the absence of a primary coronary event. However, though there is a rising prevalence of depression and its potential association with type 1 myocardial infarction (T1MI), data remains non-existent to evaluate the association with T2MI.
To identify the prevalence and risk of T2MI in adults with depression and its impact on the in-hospital outcomes.
We queried the National Inpatient Sample (2019) to identify T2MI hospitalizations using Internal Classification of Diseases-10 codes in hospitalized adults (≥ 18 years). In addition, we compared sociodemographic and comorbidities in the T2MI cohort with without comorbid depression. Finally, we used multivariate regression analysis to study the odds of T2MI hospitalizations with without depression and in-hospital outcomes (all-cause mortality, cardiogenic shock, cardiac arrest, and stroke), adjusting for confounders. Statistical significance was achieved with a value of < 0.05.
There were 331145 adult T2MI hospitalizations after excluding T1MI (median age: 73 years, 52.8% male, 69.9% white); 41405 (12.5%) had depression, the remainder; 289740 did not have depression. Multivariate analysis revealed lower odds of T2MI in patients with depression without [adjusted odds ratio (aOR) = 0.88, 95% confidence interval (CI): 0.86-0.90, = 0.001]. There was the equal prevalence of prior MI with any revascularization and a similar prevalence of peripheral vascular disease in the cohorts with depression without depression. There is a greater prevalence of stroke in patients with depression (10.1%) those without (8.6%). There was a slightly higher prevalence of hyperlipidemia in patients with depression without depression (56.5% 48.9%), as well as obesity (21.3% 17.9%). There was generally equal prevalence of hypertension and type 2 diabetes mellitus in both cohorts. There was no significant difference in elective and non-elective admissions frequency between cohorts. Patients with depression without depression also showed a lower risk of all-cause mortality (aOR = 0.75, 95%CI: 0.67-0.83, = 0.001), cardiogenic shock (aOR = 0.65, 95%CI: 0.56-0.76, = 0.001), cardiac arrest (aOR = 0.77, 95%CI: 0.67-0.89, = 0.001) as well as stroke (aOR = 0.79, 95%CI: 0.70-0.89, = 0.001).
This study revealed a significantly lower risk of T2MI in patients with depression compared to patients without depression by decreasing adverse in-hospital outcomes such as all-cause mortality, cardiogenic shock, cardiac arrest, and stroke in patients with depression.
2型心肌梗死（T2MI）是在无原发性冠状动脉事件的情况下，因氧供/需求不匹配导致的缺血性心肌损伤。然而，尽管抑郁症患病率不断上升，且其与1型心肌梗死（T1MI）可能存在关联，但尚无数据评估其与T2MI的关联。
确定抑郁症成年患者中T2MI的患病率和风险及其对住院结局的影响。
我们查询了国家住院患者样本（2019年），使用国际疾病分类第10版编码确定住院成人（≥18岁）中的T2MI住院病例。此外，我们比较了伴有和不伴有合并抑郁症的T2MI队列中的社会人口统计学和合并症情况。最后，我们使用多因素回归分析研究伴有和不伴有抑郁症的T2MI住院几率以及住院结局（全因死亡率、心源性休克、心脏骤停和中风），并对混杂因素进行调整。P值<0.05具有统计学意义。
排除T1MI后，有331145例成人T2MI住院病例（中位年龄：73岁，52.8%为男性，69.9%为白人）；41405例（12.5%）患有抑郁症，其余289740例没有抑郁症。多因素分析显示，患有抑郁症的患者发生T2MI的几率较低（调整后的比值比[aOR]=0.88，95%置信区间[CI]：0.86 - 0.90，P=0.001）。伴有和不伴有抑郁症的队列中，既往有任何血运重建的心肌梗死患病率相同，外周血管疾病患病率相似。患有抑郁症的患者中风患病率（10.1%）高于未患抑郁症的患者（8.6%）。患有抑郁症的患者高脂血症患病率（56.5%）略高于未患抑郁症的患者（48.9%），肥胖患病率（21.3%）也高于未患抑郁症的患者（17.9%）。两个队列中高血压和2型糖尿病的患病率总体相当。队列之间择期和非择期入院频率无显著差异。患有抑郁症和未患抑郁症的患者全因死亡率（aOR = 0.75，95%CI：0.67 - 0.83，P=0.001）、心源性休克（aOR = 0.65，95%CI：0.56 - 0.76，P=0.001）、心脏骤停（aOR = 0.77，95%CI：0.67 - 0.89，P=0.001）以及中风（aOR = 0.79，95%CI：0.70 - 0.89，P=0.001）风险也较低。
本研究表明，与未患抑郁症的患者相比，抑郁症患者发生T2MI的风险显著降低，抑郁症患者的全因死亡率、心源性休克、心脏骤停和中风等不良住院结局减少。
