(Circulation. 1995;91:999-1005.)
© 1995 American Heart Association, Inc.
Articles |
Depression and 18-Month Prognosis After Myocardial Infarction
From the Research Center (N.F.-S., F.L., M.T.), Montreal Heart Institute, Montreal; Department of Psychiatry (N.F.-S., F.L.), McGill University, Montreal; and Departments of Psychiatry (N.F.-S., F.L.) and Medicine (M.T.), University of Montreal, Montreal, Canada.
Correspondence to Dr Nancy Frasure-Smith, Research Center, Montreal Heart Institute, 5000 Belanger St E, Montreal, Quebec, Canada H1T 1C8.
Background We previously reported that major depression in patients in the hospital after a myocardial infarction (MI) substantially increases the risk of mortality during the first 6 months. We examined the impact of depression over 18 months and present additional evidence concerning potential mechanisms linking depression and mortality.
Methods and Results Two-hundred twenty-two patients responded to
a modified version of the National Institute of Mental Health
Diagnostic Interview Schedule (DIS) for a major depressive episode at
approximately 7 days after MI. The Beck Depression Inventory (BDI),
which measures depressive symptomatology, was also completed by 218 of
the patients. All patients and/or families were contacted at 18 months
to determine survival status. Thirty-five patients met the modified DIS
criteria for major in-hospital depression after the MI. Sixty-eight had
BDI scores 
10, indicative of mild to moderate symptoms of depression.
There were 21 deaths during the follow-up period, including 19 from
cardiac causes. Seven of these deaths occurred among patients who met
DIS criteria for depression, and 12 occurred among patients with
elevated BDI scores. Multiple logistic regression analyses showed that
both the DIS (odds ratio, 3.64; 95% confidence interval [CI], 1.32
to 10.05; P=.012) and elevated BDI scores (odds ratio, 7.82;
95% CI, 2.42 to 25.26; P=.0002) were significantly related
to 18-month cardiac mortality. After we controlled for the other
significant multivariate predictors of mortality in the data set
(previous MI, Killip class, premature ventricular contractions
[PVCs]
of 10 per hour), the impact of the BDI score remained significant
(adjusted odds ratio, 6.64; 95% CI, 1.76 to 25.09;
P=.0026). In addition, the interaction of PVCs and BDI score
marginally improved the model (P=.094). The interaction
showed that deaths were concentrated among depressed patients with PVCs
of 10 per hour (odds ratio, 29.1; 95% CI, 6.97 to 122.07;
P<.00001).
Conclusions Depression while in the hospital after an MI is a
significant predictor of 18-month post-MI cardiac mortality. Depression
also significantly improves a risk-stratification model based on
traditional post-MI risks, including previous MI, Killip class, and
PVCs. Furthermore, the risk associated with depression is greatest
among patients with 10 PVCs per hour. This result is compatible with
the literature suggesting an arrhythmic mechanism as the link between
psychological factors and sudden cardiac death and underscores the
importance of developing screening and treatment programs for post-MI
depression.
Key Words: myocardial infarction • depression • arrhythmias • prognosis
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