Background: Depression is common in cardiac patients and has been associated with adverse clinical outcome. However, little is known about predictors of the onset of depressive symptoms. We examined predictors of the ...Background: Depression is common in cardiac patients and has been associated with adverse clinical outcome. However, little is known about predictors of the onset of depressive symptoms. We examined predictors of the onset of depressive symptoms at 12 months post- percutaneous coronary intervention(PCI) in patients treated in the drug- eluting stent era. Methods: Unselected patients, free from depressive symptoms at 6 months with a depression score at 12 months treated with PCI with either drug- eluting or bare stent implantation as part of the RESEARCH registry qualified for inclusion in the current study. Patients completed the Hospital Anxiety and Depression Scale at 6 and 12 months and the Type D Personality Scale(DS14) at 6 months post- PCI. Six months was used as the baseline assessment. Results: Of 542 patients, 41(8% ) had developed significant depressive symptoms at 12 months. The occurrence of a new cardiac event between 6 and 12 months post- index event did not influence the incidence of depressive symptoms at 12 months. Depressive patients were more likely to have a type D personality(34% vs 16% , P=.003) and diabetes(24% vs 11% , P=.01) than nondepressive patients. Type D personality(odds ratio 3.04, 95% CI 1.50- 6.16) and diabetes(odds ratio 2.75, 95% CI 1.25- 6.05) were independent predictors of the onset of depressive symptoms 12 months post- PCI in adjusted analyses. In patients with neither risk factors(type D or diabetes), the incidence of depression was 5.1% with the incidence more than doubling to 13.2% and 30% for each additional risk factor. Conclusions: Type D personality and diabetes comprise risk factors for the onset of depressive symptoms post- PCI. In clinical practice, patients with these risk factors should be identified and considered for psychosocial intervention targeting depression to enhance secondary prevention.展开更多
OBJECTIVES: The goal of this research was to clarify whether the benefit of reperfusion therapy for myocardial infarction was sustained long-term and to assess the gain in life expectancy by reperfusion therapy. BACKG...OBJECTIVES: The goal of this research was to clarify whether the benefit of reperfusion therapy for myocardial infarction was sustained long-term and to assess the gain in life expectancy by reperfusion therapy. BACKGROUND: Reperfusion therapy in acute myocardial infarction reduces infarct size and increases hospital survival. METHODS: We analyzed the 20-year outcome of 533 patients(mean age 56 years; 82%men) who were randomized to either reperfusion therapy or conventional therapy during the years 1981 to 1985. RESULTS: Mean follow-up was 21 years(range 19 to 23 years). At follow-up, 101 patients(36%) of the 269 patients allocated to reperfusion treatment and only 71 patients(26%) of the 264 conventionally treated patients were alive(p=0.02). The cumulative 10-, 15-, and 20-year survival rates were 69%, 48%, and 37%after reperfusion therapy and 59%, 38%, and 27%in the control group, respectively(p=0.005). Life expectancy of the reperfusion group was 15.2 years versus 12.4 years in the conventionally treated group(p< 0.0001). Myocardial re-infarction and subsequent coronary interventions were more frequent after reperfusion therapy, particularly during the first year. In multivariable analysis, reperfusion therapy was an important independent predictor of lower mortality at long-term follow-up(hazard ratio 0.7; 95%confidence interval 0.6 to 0.8). Other independent predictors of mortality were age, impaired left ventricular function, multivessel disease, infarct size, and inability to perform an exercise test at the time of discharge. CONCLUSIONS: This is the first study demonstrating sustained(20-year) improved survival after reperfusion therapy. The gain in life expectancy was almost three years, representing about one-third of the life-years lost by myocardial infarction.展开更多
文摘Background: Depression is common in cardiac patients and has been associated with adverse clinical outcome. However, little is known about predictors of the onset of depressive symptoms. We examined predictors of the onset of depressive symptoms at 12 months post- percutaneous coronary intervention(PCI) in patients treated in the drug- eluting stent era. Methods: Unselected patients, free from depressive symptoms at 6 months with a depression score at 12 months treated with PCI with either drug- eluting or bare stent implantation as part of the RESEARCH registry qualified for inclusion in the current study. Patients completed the Hospital Anxiety and Depression Scale at 6 and 12 months and the Type D Personality Scale(DS14) at 6 months post- PCI. Six months was used as the baseline assessment. Results: Of 542 patients, 41(8% ) had developed significant depressive symptoms at 12 months. The occurrence of a new cardiac event between 6 and 12 months post- index event did not influence the incidence of depressive symptoms at 12 months. Depressive patients were more likely to have a type D personality(34% vs 16% , P=.003) and diabetes(24% vs 11% , P=.01) than nondepressive patients. Type D personality(odds ratio 3.04, 95% CI 1.50- 6.16) and diabetes(odds ratio 2.75, 95% CI 1.25- 6.05) were independent predictors of the onset of depressive symptoms 12 months post- PCI in adjusted analyses. In patients with neither risk factors(type D or diabetes), the incidence of depression was 5.1% with the incidence more than doubling to 13.2% and 30% for each additional risk factor. Conclusions: Type D personality and diabetes comprise risk factors for the onset of depressive symptoms post- PCI. In clinical practice, patients with these risk factors should be identified and considered for psychosocial intervention targeting depression to enhance secondary prevention.
文摘OBJECTIVES: The goal of this research was to clarify whether the benefit of reperfusion therapy for myocardial infarction was sustained long-term and to assess the gain in life expectancy by reperfusion therapy. BACKGROUND: Reperfusion therapy in acute myocardial infarction reduces infarct size and increases hospital survival. METHODS: We analyzed the 20-year outcome of 533 patients(mean age 56 years; 82%men) who were randomized to either reperfusion therapy or conventional therapy during the years 1981 to 1985. RESULTS: Mean follow-up was 21 years(range 19 to 23 years). At follow-up, 101 patients(36%) of the 269 patients allocated to reperfusion treatment and only 71 patients(26%) of the 264 conventionally treated patients were alive(p=0.02). The cumulative 10-, 15-, and 20-year survival rates were 69%, 48%, and 37%after reperfusion therapy and 59%, 38%, and 27%in the control group, respectively(p=0.005). Life expectancy of the reperfusion group was 15.2 years versus 12.4 years in the conventionally treated group(p< 0.0001). Myocardial re-infarction and subsequent coronary interventions were more frequent after reperfusion therapy, particularly during the first year. In multivariable analysis, reperfusion therapy was an important independent predictor of lower mortality at long-term follow-up(hazard ratio 0.7; 95%confidence interval 0.6 to 0.8). Other independent predictors of mortality were age, impaired left ventricular function, multivessel disease, infarct size, and inability to perform an exercise test at the time of discharge. CONCLUSIONS: This is the first study demonstrating sustained(20-year) improved survival after reperfusion therapy. The gain in life expectancy was almost three years, representing about one-third of the life-years lost by myocardial infarction.
