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Underestimated prognostic value of depression in patients with obstructive coronary artery disease
Quanjun Liu1,2, Han Yin1, Cheng Jiang1
1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
Depression predicts worse outcomes in coronary artery disease (CAD) patients with preserved heart function (LVEF ≥50%), but less so in those with reduced function. This highlights the need to consider depression in risk prediction models for CAD patients with normal LVEF.
Area of Science:
- Cardiology
- Psychiatry
- Clinical Research
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Depression is a common comorbidity in patients with cardiovascular diseases.
- The predictive value of depression on clinical outcomes may vary based on cardiac systolic function.
Purpose of the Study:
- To investigate the differential predictive values of depression in patients with obstructive coronary artery disease (CAD) across varying levels of cardiac systolic function.
- To assess the association between depression and major adverse cardiovascular events (MACEs), non-cardiac rehospitalizations, and mortality.
Main Methods:
- A cohort of 483 patients with obstructive CAD were assessed for depressive symptoms using the Patient Health Questionnaire 9 (PHQ-9) (score ≥5 defined depression).
- Cardiac systolic function was categorized by left ventricular ejection fraction (LVEF) as preserved (≥50%) or reduced (<50%).
- Clinical outcomes including MACEs, non-cardiac rehospitalizations, and death were tracked over a median of 26.2 months.
Main Results:
- Depression was significantly associated with increased risks of cardiovascular events and composite outcomes in patients with preserved LVEF.
- In the overall population, the predictive value of depression for MACEs, non-cardiac rehospitalizations, and composite endpoints was diminished.
- Receiver operating characteristic (ROC) analyses indicated depression as a key predictor, with AUC reaching 0.64-0.67 when combined with other features.
Conclusions:
- Contrary to general assumptions, depression shows a stronger link to adverse clinical outcomes in CAD patients with preserved LVEF compared to those with reduced LVEF.
- These findings underscore the importance of addressing depressive symptoms in CAD patients with normal systolic function.
- Integrating psychological factors like depression into risk prediction models for CAD patients may enhance prognostic accuracy.
Objective:
The aim of this study was to explore the different predictive values of depression among patients with different cardiac systolic function levels.
Methods:
Four hundred eighty-three consecutive patients with obstructive coronary artery disease (CAD) were included the depressive state was assessed using the Chinese version of the Patient Health Questionnaire 9 (PHQ-9). Depression was defined as have depressive symptoms with a PHQ-9 score ≥5. The level of cardiac systolic function was classified as left ventricular ejection fraction (LVEF) ≥50 and <50%.
Results:
Over a median of 26.2 months, 421 patients completed the follow-up and experienced 101 major adverse cardiovascular events (MACEs), 45 non-cardiac rehospitalizations, and 17 deaths. Predictors for clinical outcomes in patients with different cardiac systolic function levels were not the same. For participants with preserved LVEF, depression was associated with increased risks for cardiovascular events and composite outcomes. However, when focusing the whole population, predictive values of depression for MACEs, non-cardiac rehospitalizations, and composite endpoints all dropped. Receiver operating characteristic (ROC) analyses further confirmed that depression was the one of the main predictors for all clinical outcomes. With the combination of other simple features, area under curve (AUC) could reach 0.64-0.67.
Conclusions:
Inconsistent with the general impression, depression is found to have a closer linkage with clinical outcomes in CAD patients with preserved LVEF rather than in those with decreased LVEF. These findings appeal for more attention on CAD patients with depressive symptoms and comparatively normal LVEF. Including psychological factors may be a good attempt when constructing risk prediction models.
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