Key result
Depression linked to ~3-fold higher 5-year mortality in stable CAD post-MI.
Why the study?
The impact of depressive disorder on the clinical course and 5-year prognosis of patients with myocardial infarction and stable coronary artery disease was not well characterized.
Does the presence of a depressive disorder worsen clinical symptoms and 5-year survival in patients with stable CAD >6 months post-MI?
Cohort (n=101)
No
Does the presence of a depressive disorder worsen clinical symptoms and 5-year survival in patients with stable CAD >6 months post-MI?
Untreated depressive disorder in post-myocardial infarction patients with stable CAD is associated with worse angina symptoms, reduced exercise tolerance, and significantly increased 5-year mortality.
Answers are grounded in this paper and cite their sources.
Depression screening may aid risk stratification post-MI; leaves open whether treatment improves survival in stable CAD.
Aim. To assess the features of the clinical picture of coronary artery disease (CAD) and the prognosis of patients with myocardial infarction with depressive disorder (DD). Materials and methods. We examined 101 patients with stable CAD who had myocardial infarction more than six months ago: 67 CAD patients with depression (Group 1) and 34 CAD patients without depression (Group 2). The clinical picture of CAD was assessed by complaints, angina self-monitoring diaries, and exercise tests. The presence and severity of DD was determined using psychometric scales: BDI (Beck Depression Scale), HADS (Hospital Anxiety and Depression Scale) and the opinion of a psychiatrist. Five-year survival information was obtained through telephone interviews with patients and their relatives. Results. In patients with CAD and DD in comparison with patients without DD self-monitoring diaries revealed more frequent angina attacks: 9 [6; 12] vs 6 [4; 7] per week (p=0.0001), the greater need for sublingual nitrates: 2 [0; 9] pills vs 0 [0; 4] pills (p=0.0001). DD significantly reduced exercise tolerance: 370 [250; 450] meters vs 435 [350; 500] meters using the six-minute walk test (p=0.04), according to the results of bicycle ergometry – 50 [25; 75] W vs 75 [50; 75] W (p=0.03). After 5 years of follow-up patients with comorbidities (CAD and DD) had a greater number of deaths: 13 (19.4%) vs 2 (5.9%), respectively, survived – 54 (80.6%) vs 32 (94.1%) (Gehan–Wilcoxon test, p=0.04). Conclusion. The comorbidity CAD and DD leads to a worsening of the clinical course of CAD and prognosis, which actualizes the need for verification of the diagnosis of DD and timely prescription of antidepressant therapy.
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Nonka et al. (2024) conducted a cohort in Stable coronary artery disease post-myocardial infarction (n=101). Depressive disorder vs. No depressive disorder was evaluated on 5-year mortality (p=0.04). Depressive disorder significantly decreased 5-year survival in patients with stable coronary artery disease post-myocardial infarction, with 19.4% mortality compared to 5.9% in those without depression.
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