老年急性心肌梗死患者急诊介入治疗术后合并抑郁的影响因素及预后分析

Risk factor and prognosis of concurrent depression in elderly patients with acute myocardial infarction treated with percutaneous coronary intervention

目的探讨老年急性心肌梗死（AMI）患者行急诊经皮冠状动脉介入治疗（PCI）术后合并抑郁的相关因素及对预后的影响。方法入选因AMI行急诊PCI治疗且资料完整患者295例，行抑郁自评量表（SDS）测试，标准分≥53分视为抑郁。根据年龄将患者分为老年（年龄≥60岁，144例）组和中青年（年龄〈60岁，151例）组。抑郁发生的相关因素采用多元Logistic回归分析。患者均随访1年，比较再住院率、主要不良心血管事件（MACE）发生率及12个月时左室射血分数（LVEF）。结果老年组抑郁发生率明显高于中青年组[41．7％（60／144）比21．2％（32／151）]。差异有统计学意义（P〈O．05）。女性、高血压病及2型糖尿病是老年AMI患者PCI术后发生抑郁的独立危险因素（P〈0．05）。老年组抑郁患者再住院率和MACE发生率明显高于非抑郁患者[18．3％（11／60）比6．0％（5／84）和15．0％（9／60）比4．8％（4／84）]，LVEF明显低于非抑郁患者[（41．50±2．25）％比（49．76±2．93）％]，差异有统计学意义（P〈0．05）。老年组抑郁患者LVEF明显低于中青年组抑郁患者[（41．50±2．25）％比（51．50±2．32）％]，差异有统计学意义（P〈0．05）。结论老年AMI患者急诊PCI术后抑郁的发病率较高；女性、高血压病及2型糖尿病为术后抑郁的重要危险因素；抑郁明显影响患者预后，尤其对老年患者的LVEF影响明显。

Objective To study the risk factor and prognosis of concurrent depression in elderly patients with acute myocardial infarction （AMI） treated with percutaneous coronary intervention （PCI）. Methods Two hundred and ninety-five AMI patients who＇ received PCI and whose clinical data were complete were selected. Depression was determined by a self-rating scale （SDS）, and was confirmed when SDS standard score ≥53 scores. The patients were divided into 2 groups according to the ages： senium （age ≥ 60 years, 144 cases） group and younger group （age〈60 years, 151 cases）. Multiple Logistic regression analysis was used to analyze the related factors of depression. The patients were followed up for 1 year, and the rehospitalization rate, incidence of major adverse cardiovascular events （MACE） and left ventricular ejection fraction （LVEF） at 12 months were compared. Results The incidence of depression in senium group was significantly higher than that in younger group： 41.7% （60/144） vs. 21.2%（32/151）, and there was statistical difference （P 〈 0.05）. Female gender, hypertension and type 2 diabetes mellitus were the independent risk factor for depression in patients with AMI after PCI （P 〈 0.05）. In senium group, the rehospitalization rate and incidence of MACE in patients with depression were significantly higher than those in patients without depression： 18.3% （11/60） vs. 6.0% （5/84） and 15.0% （9/60） vs. 4.8% （4/84）, the LVEF was significantly lower than that in patients without depression： （41.50 ± 2.25）% vs. （49.76 ± 2.93）%, and there were statistical differences （P〈 0.05）. The LVEF in patients with depression of senium group was significantly lower than that in patients with depression of younger group： （41.50±2.25）% vs. （51.50 ±2.32）%, and there was statistical difference （P 〈 0.05）. Conclusions The elderly AMI patients treated with PCI have higher rates of depression. Female gender, hypertension and type 2 diabetes mellitus are the important risk factor for depression after PCI. Depression has a significant effect on the prognosis of AMI patients, especially on LVEF in elderly patients.