抑郁对急性冠脉综合征患者经皮冠状动脉介入术后心血管预后影响的真实世界研究

Impact of depression on the cardiovascular prognosis of patients with acute coronary syndrome after percutaneous coronary interventions:a real-world study

目的为中国急性冠脉综合征(ACS)患者合并抑郁的现状以及抑郁对ACS患者心血管预后的影响提供有力的流行病学资料。方法连续入选2017年4月到2019年4月因ACS在西安交通大学第一附属医院心内科接受经皮冠状动脉介入术(PCI)治疗的患者,记录患者主要不良心血管事件(MACE)的发生以及评估抑郁症筛查量表(PHQ)。分析患者的抑郁评分变化以及与MACE发生的关系,计算MACE发生风险,分析不同时间点发生的抑郁对MACE发生的影响,最后利用时间依赖变量分析(Cox回归模型以及联合模型)探讨重复测量的抑郁对于MACE发生的风险。结果入组并完成随访910例ACS患者,其中女210例,年龄60(53,66)岁,抑郁患者占比达26.4%(240/910)。基线抑郁是ACS患者MACE发生的独立危险因素[HR=2.42,95%CI 1.8~3.26,P<0.001]。人群归因分数(PAF)分析显示与基线抑郁相比,末次访视抑郁与MACE发生的关系更为密切[30.16%对18.75%]。同时,时间依存协变量分析显示重复测量的抑郁是MACE发生的独立危险因素(HR=4.01,95%CI 2.97~5.41,P<0.001)。结论ACS患者合并抑郁并不少见,入组基线以及重复测量的抑郁显著增加了ACS患者心血管不良预后的风险,需重视该类患者并进行必要的定期抑郁评估。

Objective To evaluate the condition of acute coronary syndrome(ACS)patients comorbid with depression in China and the effect of depression on their cardiovascular prognosis.Methods From April 2017 to April 2019,patients were consecutively enrolled who received percutaneous coronary intervention(PCI)for ACS in Department of Cardiology of the First Affiliated Hospital of Xi'an Jiaotong University.Major adverse cardiovascular events(MACE),as well as patient health questionnaire(PHQ)self-rating scales were evaluated at each visit.Different trajectories of time-varying PHQ scores and their relationship with MACE were identified.Cox proportional hazards regression models were used to evaluate the hazard ratio(HR)for MACE.Population attributable fractions(PAF)of depression at different time were analyzed to evaluate their contributions to MACE.Finally,time-dependent covariate analyses of repeated measurements of depression were conducted in time-dependent cox models and joint models to estimate the HR of the depression for MACE.Results A total of 910 patients with ACS and accepted follow-ups were recruited,including 210 females,aged 60(53,66)years,and the proportion of patients with depression was 26.4%(240/910).We found that baseline depression was the independent risk factor for MACE(HR=2.42,95%CI 1.8-3.26,P<0.001).The PAF of depression at last visit was higher(30.16%)than the PAF of baseline depression(18.75%).Repeated measurements of depression were the independent risk factors of MACE(HR=4.01,95%CI 2.97-5.41,P<0.001).Conclusion Depression is common in ACS patients.Both baseline depression and repeated measurements of depression could increase the risk of MACE.More attention and regular screen need to be paid to these patients.