Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis

作者：Meijer A^*; Conradi H J; Bos E H; Anselmino M; Carney R M; Denollet J; Doyle F; Freedland K E; Grace S L; Hosseini S H; Lane D A; Pilote L; Parakh K; Rafanelli C; Sato H; Steeds R P; Welin C; de Jonge P

来源：The British Journal of Psychiatry, 2013, 203(2): 90-102.

DOI：10.1192/bjp.bp.112.111195

Background %26lt;br%26gt;The association between depression after myocardial infarction and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity. %26lt;br%26gt;Aims %26lt;br%26gt;To combine original data from studies on the association between post-infarction depression and prognosis into one database, and to investigate to what extent such depression predicts prognosis independently of disease severity. %26lt;br%26gt;Method %26lt;br%26gt;An individual patient data meta-analysis of studies was conducted using multilevel, multivariable Cox regression analyses. %26lt;br%26gt;Results %26lt;br%26gt;Sixteen studies participated, creating a database of 10 175 post-infarction cases. Hazard ratios for post-infarction depression were 1.32 (95% CI 1.26-1.38, P%26lt;0.001) for all-cause mortality and 1.19 (95% CI 1.14-1.24, P%26lt;0.001) for cardiovascular events. Hazard ratios adjusted for disease severity were attenuated by 28% and 25% respectively. %26lt;br%26gt;Conclusions %26lt;br%26gt;The association between depression following myocardial infarction and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score.

• 出版日期2013-8