Abstract 18256: Depression Is A Better Predictor Of Cardiac Death Than Inflammatory Burden: 3 Year Follow-up Of Patients With Stable Coronary Artery Disease
Purpose: We examined whether depressive symptoms can predict future cardiovascular events independently of the inflammatory burden in patients with stable coronary artery disease (CAD).
Methods: We enrolled 561 consecutive patients (82% men) from 4 hospitals around Athens (median follow-up 34 months). All patients were interviewed and blood was taken for C-reactive protein (CRP) and lipids measurements. Depressive symptomatology was also assessed with the Zung Self-Rating Depression Scale (ZDRS) [range 0-100]. We used univariate and multivariate Cox regression analysis. Primary endpoints were cardiovascular deaths and secondary endpoints hospitalizations for acute coronary syndrome, arrhythmic event, stroke or revascularizations because of clinical deterioration.
Results: Follow-up data were obtained by 504 patients. One-hundred and twenty patients (23.8%) presented with cardiovascular events (19 cardiac deaths, 20 arrhythmic events, 2 strokes, 48 acute coronary syndromes, 31 revascularizations). ZDRS score was a predictor of death (hazard ratio [HR]=1.076, 95% confidence interval [CI]:1.034-1.119, p<0.001). Patients with depression (i.e. ZDRS score ≥50) had 5 times greater risk of death after adjustment for traditional risk factors for CAD (HR= 5.09 with 95% CI:1.72-15.11, p= 0.003) [Figure].
In addition, ZDRS score remained a significant predictor of cardiac death after adjustment for traditional risk factors for CAD and CRP levels (HR=1.094 with 95% CI:1.038-1.153, p=0.001). Furthermore, ZDRS score was an independent predictor of all cardiovascular endpoints after adjustment for traditional risk factors and CRP levels (HR=1.028, 95% CI:1.005-1.052, p=0.018). Discriminant analysis showed that ZDRS was the strongest discriminator for occurrence of death (λ-Wilk's=0.969).
Conclusions: Depressive symptomatology predicts better the occurrence of cardiac death than the inflammatory burden in patients with stable CAD.
- © 2010 by American Heart Association, Inc.