January 1, 2011Open Access
Longitudinal Risk of Cardiovascular Events in Relation to Depression Symptoms After Discharge Among Survivors of Myocardial Infarction - Osaka Acute Coronary Insufficiency Study (OACIS) -
Key Result
Severe depression symptoms 1 year after the onset of myocardial infarction significantly increased the risk of subsequent cardiovascular events in male patients (HR 1.67) compared to those with minimal symptoms.
Study Design
Type
Cohort (n=1,587)
Multicenter
Yes
Structured PICO
Do depression symptoms 1 year after onset of myocardial infarction predict subsequent cardiovascular events in survivors?
P
Population
1,587 survivors of acute myocardial infarction (17.6% female, mean age 62.5 years) who were event-free at 1 year, followed for a median of 2.9 years to assess the impact of depression symptoms on subsequent cardiovascular events.
E
Exposure
High depression symptoms (top tertile of SDS score ≥42 for men, ≥44 for women, or 1-SD increment in SDS score) assessed 1 year after MI onset.
C
Comparator
Low depression symptoms (bottom tertile of SDS score ≤33 for men, ≤35 for women) assessed 1 year after MI onset.
O
Outcome
Composite of cardiovascular events (cardiac death, stroke death, non-fatal myocardial reinfarction, coronary angioplasty or bypass, readmission for heart failure, unstable angina, stroke or uncontrolled arrhythmia).composite
Depression symptoms 1 year after myocardial infarction are a significant independent predictor of subsequent long-term cardiovascular events in male survivors.
Main Result
Hazard Ratio: 1.67 (95% CI 1.01–2.77)
Absolute Event Rate: 10.4% vs 6.2%
p-value: p=0.04
Limitations
- Did not examine changes in clinical characteristics and antidepressant use after onset
- Small number of female patients may limit meaningful analysis for women
- Potential selection bias as 39.7% of patients did not evaluate depressive symptoms at 1 year
Abstract
BACKGROUND: The purpose of this study was to investigate the association between depression symptoms 1 year after onset and subsequent cardiovascular events among survivors of myocardial infarction (MI). METHODS AND RESULTS: The participants were recruited from respondents to a district-based survey known as the Osaka Acute Coronary Insufficiency Study. Of 4,271 eligible MI patients, 1,951 completed the Zung Self-Rating Depression Scale (SDS) at their 1-year follow-up examination. After excluding patients who experienced cardiovascular events within 1 year, the data for the remaining 1,307 male patients and 280 female patients were analyzed. Among male patients, depression status at 1 year after onset of MI was significantly related to risk of subsequent cardiovascular events throughout the follow-up period (median 2.9 years). The male patients in the top vs. bottom tertiles of SDS scores (top tertile being ≥42) had a multivariable-adjusted hazard ratio (HR) of 1.67 (95% confidence interval (CI) 1.01-2.77, P=0.04), and a 1-SD increment in SDS score was significantly related to a heightened risk of cardiovascular events, with a multivariable-adjusted HR of 1.30 (95%CI 1.07-1.58, P=0.01). There were no significant associations between SDS scores and cardiovascular events among female patients. CONCLUSIONS: Depression symptoms 1 year after onset of MI are a significant predictor of subsequent cardiovascular events for male patients.