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Depression and Angina Among Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention: The
Robert W Yeh1, Hector Tamez1, Eric A Secemsky1
1Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Insights
Depression is common in chronic total occlusion patients undergoing percutaneous coronary intervention. Despite more severe baseline symptoms, depressed patients showed greater health status improvement one year after PCI.
Area of Science:
- Cardiology
- Psychiatry
- Health Services Research
Background:
- Depression is prevalent in cardiovascular disease patients but understudied in Chronic Total Occlusion (CTO).
- The impact of depression on treatment response following percutaneous coronary intervention (PCI) in CTO patients is not well understood.
Purpose of the Study:
- To determine the prevalence of depression among CTO patients.
- To compare symptom improvement after PCI in depressed versus nondepressed CTO patients.
Main Methods:
- Analysis of 811 patients from the OPEN-CTO registry.
- Assessment of health status changes using the Seattle Angina Questionnaire (SAQ) and Rose Dyspnea Score from baseline to 1-year post-PCI.
- Depression screening using the Personal Health Questionnaire-8, with multivariable regression to assess the association between health status and depression.
Main Results:
- 190 patients (23%) screened positive for major depression; only 6.3% received antidepressant therapy at baseline.
- Depressed patients reported more severe baseline angina.
- Depressed patients demonstrated significantly greater improvement in health status (SAQ Summary: 31.4 vs. 24.2, p < 0.001) and adjusted SAQ Summary improvement (5.48 ± 1.81, p = 0.003) at 1-year post-PCI compared to nondepressed patients.
Conclusions:
- Depression is a common comorbidity in CTO patients undergoing PCI.
- Despite higher baseline symptom burden, depressed CTO patients experience significant improvements in health status after PCI.
- Few CTO patients with depression receive baseline antidepressant treatment, highlighting a potential area for intervention.
Objectives:
This study sought to examine depression prevalence among chronic total occlusion (CTO) patients and compared symptom improvement among depressed and nondepressed patients after percutaneous coronary intervention (PCI).
Background:
Depression in cardiovascular patients is common, but its prevalence among CTO patients and its association with PCI response is understudied.
Methods:
Among 811 patients from the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry, we evaluated change in health status between baseline and 1-year post-PCI, as measured by the Seattle Angina Questionnaire (SAQ) and the Rose Dyspnea Score. Depression was defined using the Personal Health Questionnaire-8. The independent association between health status and depression following PCI was assessed using multivariable regression.
Results:
Among the 811 patients, 190 (23%) screened positive for major depression, of whom 6.3% were on antidepressant therapy at intervention. Depressed patients experienced more baseline angina, but by 1-year post-PCI they experienced greater improvements than nondepressed patients (change in SAQ Summary: 31.4 ± 22.4 vs. 24.2 ± 20.0; p < 0.001). After adjustment, baseline depressed patients had more improvement in health status (adjusted difference in SAQ Summary improvement, depressed vs. nondepressed: 5.48 ± 1.81; p = 0.003).
Conclusions:
Depression is common among CTO PCI patients, but few were treated with antidepressants at baseline. Depressed patients had more severe baseline angina and significant improvement in health status after PCI. (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion [OPEN-CTO]; NCT02026466).
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