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Depression and Disease Severity in Patients with Premature Acute Coronary Syndrome - 31/12/13

Doi : 10.1016/j.amjmed.2013.09.026 
Roxanne Pelletier, PhD a, Kim L. Lavoie, PhD b, Simon L. Bacon, PhD c, George Thanassoulis, MD, MSc d, Nadia A. Khan, MD, MSc e, Louise Pilote, MD, MPH, PhD a, f,
for the

GENESIS-PRAXY Investigators

  See Appendix A for a list of Co-Investigators for GENESIS-PRAXY.
Igor Karp, Simon Bacon, Jafna Cox, Kaberi Dasgupta, Stella Daskalopoulou, Mark Eisenberg, James Engert, William Ghali, Karin Humphries, Nadia Khan, Kim Lavoie, Colleen Norris, Doreen Rabi, Derek So, Ken Stark, Vicky Tagalakis

a Division of Clinical Epidemiology, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada 
b University of Quebec in Montreal and Research Centre, Hôpital du Sacré-Coeur de Montréal, Québec, Canada 
c Concordia University and Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada 
d Department of Medicine and Research Institute, McGill University Health Center, Montréal, Québec, Canada 
e Department of Medicine, Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, British Columbia, Canada 
f Division of Internal Medicine, McGill University, Montréal, Québec, Canada 

Requests for reprints should be addressed to Louise Pilote, MD, MPH, PhD, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Ave West, V Building, Room 2.17, Montreal, Quebec, H3A 1A1.

Abstract

Objectives

The association between depression and cardiovascular disease severity in younger patients has not been assessed, and sex differences are unknown. We assessed whether major depression and depressive symptoms were associated with worse cardiovascular disease severity in patients with premature acute coronary syndrome, and we assessed sex differences in these relationships.

Methods

We enrolled 1023 patients (aged ≤55 years) hospitalized with acute coronary syndrome from 26 centers in Canada, the United States, and Switzerland, through the GENdEr and Sex determInantS of cardiovascular disease: From bench to beyond-Premature Acute Coronary Syndrome study. Left ventricular ejection fraction, Killip class, cardiac troponin I, and Global Registry of Acute Coronary Events score data were collected through chart review.

Results

The sample comprised 248 patients with major depression and 302 women. In univariate analyses, major depression was associated with a lower likelihood of having an abnormal left ventricular ejection fraction (odds ratio, 0.70; 95% confidence interval, 0.51-0.97; P = .03) and lower troponin I levels (estimate, −4.04; 95% confidence interval, −8.01 to −0.06; P = .05). After adjustment for sociodemographic and clinical characteristics, neither major depression nor depressive symptoms were associated with disease severity indices, and there were no sex differences.

Conclusion

The increased risk of adverse events in depressed patients with premature acute coronary syndrome is not explained by disease severity.

El texto completo de este artículo está disponible en PDF.

Keywords : Acute coronary syndrome, Depression, Disease severity, Epidemiology, Women


Esquema


 Funding: This study was funded by the Canadian Institutes of Health Research and the Heart and Stroke Foundations of Quebec, Nova Scotia, Alberta, Ontario, Yukon and British Columbia, Canada. RP is supported by a Canadian Institute of Health Research Award. KLL is funded by a Canadian Institutes of Health Research New Investigator award and a Fonds de recherche en santé Québec chercheur-boursier award. SLB is supported by a Canadian Institutes of Health Research New Investigator award and a Fonds de recherche en santé Québec chercheur-boursier award. GT is funded by a Fonds de recherche en santé Québec chercheur-boursier clinicien junior I award. NK is funded by a Michael Smith Foundation for Health Research Career Scientist award. LP is supported by a Fonds de recherche en santé Québec award and holds a James McGill Chair in medicine.
 Conflict of Interest: None.
 Authorship: All authors had access to the data and played a role in writing this manuscript.


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