Brief Depression Screening with the PHQ-2 Associated with Prognosis Following Percutaneous Coronary Intervention with Paclitaxel-Eluting Stenting
Key result
Depressive symptoms linked to ~90% higher risk of death or non-fatal MI following PCI.
- HR 1.90
- 95% CI 1.05-3.44
- P=0.03
- n=796
Why the study?
Depression is associated with adverse prognosis in cardiac patients, necessitating brief valid instruments to identify depression after PCI with paclitaxel-eluting stenting.
Does depression screening with the PHQ-2 predict adverse events in patients following PCI with paclitaxel-eluting stenting?
Population
796 consecutive PCI patients treated with paclitaxel-eluting stenting at a university medical centre
Comparison
PHQ-2 depression screening cutoff score >=2 vs <2
Design
Prospective follow-up study
Follow-up
Mean 1.4 years
Authors
Discussion
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Member takes
Implication
PHQ-2 scores were associated with adverse post-PCI events; hypothesis-generating for depression screening, prospective trials needed before adoption.
Study Design
Type
Cohort (n=796)
Multicenter
No
Structured PICO
Does depression screening with the PHQ-2 predict adverse events in patients following PCI with paclitaxel-eluting stenting?
P
Population
796 patients who underwent percutaneous coronary intervention with paclitaxel-eluting stenting and survived 30 days, followed for a mean of 1.4 years.
E
Exposure
Depression screening using the two-item Patient Health Questionnaire (PHQ-2) at baseline, specifically using a cutoff score of >=2.
C
Comparator
Patients with a PHQ-2 score <2 (no significant depressive symptoms).
O
Outcome
Composite of death or non-fatal myocardial infarction (MI) at a mean follow-up of 1.4 years.composite
Main Result
Hazard Ratio: 1.9 (95% CI 1.05–3.44)
Absolute Event Rate: 8.8% vs 4.7%
p-value: p=0.03
A brief two-item depression screening tool (PHQ-2) with a cutoff of >=2 is independently associated with an increased risk of death or non-fatal MI following PCI, particularly in men.
Limitations
- Small number of clinical events (47) potentially leading to overfitting of the adjusted models.
- Selection bias due to the exclusion of patients who died within the first 30 days post-PCI.
- Assessment of depressive symptoms close to the index event may reflect underlying somatic disease rather than true depression.
- Lack of information on the specific causes of death.
- No data on depression status prior to the index PCI, use of psychotropic medication, or participation in cardiac rehabilitation.
- Unknown adherence to prescribed clopidogrel therapy.
Cite This Study
Pedersen et al. (2009) conducted a cohort in Coronary Artery Disease post-Percutaneous Coronary Intervention (n=796). Depressive symptoms (PHQ-2 score ≥2) vs. Non-depressed (PHQ-2 score <2) was evaluated on Adverse event (combination of all-cause death or non-fatal myocardial infarction) (HR 1.90, 95% CI 1.05-3.44, p=0.03). Depressive symptoms, identified by a PHQ-2 score of ≥2, were independently associated with a nearly two-fold increased risk of death or non-fatal myocardial infarction (HR 1.90) following PCI.