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Depression following myocardial infarction. Impact on 6-month survival
N Frasure-Smith1, F Lespérance, M Talajic
1Research Center, Montreal Heart Institute, Quebec, Canada.
Insights
Major depression significantly increases cardiac mortality risk in myocardial infarction (MI) patients within six months post-discharge. This finding highlights depression as an independent risk factor for post-MI survival.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Myocardial infarction (MI) survivors face significant risks post-discharge.
- The impact of major depression on cardiac mortality after MI requires further investigation.
Purpose of the Study:
- To determine if major depression diagnosis independently predicts cardiac mortality in hospitalized MI patients within 6 months of discharge.
Main Methods:
- Prospective study of 222 MI patients using a modified NIMH Diagnostic Interview Schedule for major depressive episode.
- Cox proportional hazards regression analyzed depression's impact, controlling for clinical predictors like left ventricular dysfunction and prior MI.
Main Results:
- Major depression was a significant predictor of 6-month cardiac mortality (HR=5.74).
- This association remained significant after adjusting for left ventricular dysfunction and previous MI (aHR=4.29).
- Twelve cardiac deaths occurred within 6 months, all in patients with depression.
Conclusions:
- Major depression is an independent risk factor for cardiac mortality in post-MI patients.
- Depression's impact on mortality is comparable to left ventricular dysfunction and prior MI history.
- Further research is needed on depression treatment's effect on post-MI survival.
Objective:
To determine if the diagnosis of major depression in patients hospitalized following myocardial infarction (MI) would have an independent impact on cardiac mortality over the first 6 months after discharge.
Design:
Prospective evaluation of the impact of depression assessed using a modified version of the National Institute of Mental Health Diagnostic Interview Schedule for major depressive episode. Cox proportional hazards regression was used to evaluate the independent impact of depression after control for significant clinical predictors in the data set.
Setting:
A large, university-affiliated hospital specializing in cardiac care, located in Montreal, Quebec.
Patients:
All consenting patients (N = 222) who met established criteria for MI between August 1991 and July 1992 and who survived to be discharged from the hospital. Patients were interviewed between 5 and 15 days following the MI and were followed up for 6 months. There were no age limits (range, 24 to 88 years; mean, 60 years). The sample was 78% male.
Primary Outcome Measure:
Survival status at 6 months.
Results:
By 6 months, 12 patients had died. All deaths were due to cardiac causes. Depression was a significant predictor of mortality (hazard ratio, 5.74; 95% confidence interval, 4.61 to 6.87; P = .0006). The impact of depression remained after control for left ventricular dysfunction (Killip class) and previous MI, the multivariate significant predictors of mortality in the data set (adjusted hazard ratio, 4.29; 95% confidence interval, 3.14 to 5.44; P = .013).
Conclusion:
Major depression in patients hospitalized following an MI is an independent risk factor for mortality at 6 months. Its impact is at least equivalent to that of left ventricular dysfunction (Killip class) and history of previous MI. Additional study is needed to determine whether treatment of depression can influence post-MI survival and to assess possible underlying mechanisms.