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Published on: May 22, 2019
Depression and risk of stroke and mortality after percutaneous coronary intervention: A nationwide population study
Dae Young Cheon1, Yong-Moon Park2,3, Myung Soo Park1
1Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, South Korea.
Insights
Pre-existing depression increases stroke and death risk after percutaneous coronary intervention (PCI). Managing depression may improve cardiovascular outcomes in PCI patients, especially those under 65.
Area of Science:
- Cardiovascular Medicine
- Psychiatry
- Public Health
Background:
- Limited evidence links depression to adverse outcomes post-percutaneous coronary intervention (PCI).
- Investigating depression's role in stroke and cardiovascular risk after PCI is crucial.
Purpose of the Study:
- To examine the association between pre-existing depression and the risk of new-onset stroke and other cardiovascular outcomes in patients who underwent PCI.
Main Methods:
- A nationwide retrospective cohort study of 164,198 patients who underwent PCI between 2010-2017.
- Depression was identified using ICD-10 codes prior to PCI.
- Multivariable Cox regression analysis assessed outcomes including stroke, myocardial infarction, revascularization, and all-cause mortality.
Main Results:
- Depression was associated with a 27% increased risk of acute stroke (aHR 1.27) and a 25% increased risk of all-cause mortality (aHR 1.25).
- An 8% increased risk of revascularization (aHR 1.08) was also observed in patients with depression.
- These associations were more pronounced in patients under 65 years.
Conclusions:
- Pre-existing depression is linked to higher risks of stroke and mortality following PCI.
- Depression management may be beneficial for reducing stroke risk and improving cardiovascular outcomes post-PCI.
- The impact of depression on outcomes is particularly significant in younger patients (<65 years).
Background:
Limited evidence exists on the role of depression in the risk of developing stroke and other cardiovascular outcomes in patients who have undergone percutaneous coronary interventions (PCI). We investigated this relationship with data from the Korean National Health Insurance Service database.
Methods:
Our nationwide retrospective cohort study included 164,198 patients who had undergone PCI between 2010 and 2017. Depression was defined with the ICD-10 codes recorded prior to the PCI. The primary outcome was a new-onset stroke following the PCI. Secondary outcomes included PCI with myocardial infarction (MI), revascularization (PCI or coronary artery bypass grafting), and all-cause mortality. A multivariable Cox proportional hazards regression analysis was used to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI), adjusting for potential confounders, including sociodemographic and lifestyle factors, comorbidities, and MI at the index PCI.
Results:
Over a median follow-up of 5.0 years, acute stroke occurred in 5.7% of patients with pre-existing depression (17.4% of the study population), compared to 3.5% of those without depression. Depression was associated with a 27% increased risk of acute stroke (aHR 1.27, 95% CI 1.20-1.35). Additionally, depression was linked with a 25% elevated risk of all-cause death (aHR 1.25, 95% CI, 1.21-1.29) and an 8% increased risk of revascularization (aHR 1.08, 95% CI 1.04-1.11). The associations with the risk of stroke and all-cause mortality were stronger in patients under 65 years.
Conclusions:
Our findings suggest that pre-existing depression may increase the risk of stroke and all-cause mortality following PCI, particularly in patients under 65 years. Additionally, depression was significantly associated with an increased need for revascularization. This underscores the potential benefits of managing depression to reduce stroke risk and overall cardiovascular outcomes following PCI.
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