冠状动脉介入术后患者抑郁障碍及其与预后的关系

Prognostic significance of depression in patients undergoing percutaneous coronary intervention

目的探讨经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后冠心病患者抑郁障碍的患病率及其和临床预后的关系。方法采用24项汉密尔顿抑郁量表(Hamilton depression rating scale,HAMD)对400例PCI患者术前及术后2周分别进行抑郁障碍评分,根据术后2周的抑郁障碍评分分为抑郁组(HAMD≥21分)和非抑郁组(HAMD<21分),并于出院后对两组患者进行12个月的临床随访。随访终点为12个月内的主要不良心血管事件(major adverse cardiovascular event,MACE),包括全因死亡、非致死性心肌梗死和靶病变重建(target lesion revascularization,TLR)。结果术前符合HAMD抑郁诊断标准的患者为102例(25.5%),术后2周符合诊断标准的患者为154例(38.5%),PCI术后患者的抑郁患病率较术前明显增高(P<0.001)。术后抑郁患者出院后12个月内有31例(20.1%)发生了MACE,明显高于无抑郁的患者(19例,7.7%),P<0.001。Logistic多因素回归分析显示抑郁状态是PCI术后患者12个月MACE的独立危险因素(OR2.34,95%CI1.26～4.03,P=0.024)。结论PCI术后有较高比例的患者存在不同程度的抑郁状态。术后抑郁状态是PCI术后患者发生MACE的独立危险因素。

Objective To investigate the impact of depression on clinical outcomes for patients with coronary artery disease undergoing percutaneous coronary intervention （PCI）. Methods Four hundred patients treated with PCI were assessed by 24-item Hamilton Depression Rating Scale （HAMD） one day before and two weeks after the procedure. Patients who scored≥21 were defined as under depression. All patients were followed up for 12 months after coronary stenting for the occurrence of major adverse cardiovascular events （MACE） including all-cause mortality, nonfatal myocardial infarction or target lesion revascularization. Results Depression was present in 38.5% （n=154） of patients after procedure, which was significantly higher than that before procedure （25.5%, P0.001）. Among patients with post-procedure depression, the MACE rate was 20.1% during the 12 months of follow-up, which was significantly higher than that among patients without depression （7.7%, P0.001）. After adjustment for other factors that affect cardiovascular outcome, post-procedure depression was an independent predictor of 12-month MACE （OR 2.34, 95% CI 1.26-4.03, P0.01）. Conclusion Patients treated with PCI had a high prevalence of depression, and post-procedure depression is an independent predictor of 12-month MACE.