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CLINICAL RESEARCH: MYOCARDIAL INFARCTION

Depression Is a Risk Factor for Mortality After Myocardial Infarction

Fact or Artifact?

Chris Dickens, PhD^_*,_*, Linda McGowan, PhD^_*, Carol Percival, PhD^_*, Barbara Tomenson, MSc^_*, Lawrence Cotter, MD, Anthony Heagerty, MD and Francis Creed, MD^_*

^_* Psychological Medicine Research Group, Department of Psychiatry, Manchester University
Department of Cardiology, Manchester Royal Infirmary, Manchester, England

Manuscript received October 13, 2006; revised manuscript received January 22, 2007, accepted January 28, 2007.

^_* Reprint requests and correspondence: Dr. Chris Dickens, Department of Psychiatry, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, England. (Email: chris.dickens{at}manchester.ac.uk).

Objectives: This study sought to investigate the long-term impact of depression on cardiac mortality after myocardial infarction (MI) and to assess whether the timing of depression influences the findings.

Background: Previous studies have shown that depression increases the risk of cardiac death after MI, although some studies with robust methodology have failed to show this effect. Clinical trials of depression treatments have failed to improve mortality. Until the relationship between depression and post-MI mortality is understood fully, clinical trials aimed at reducing mortality by treating depression remain premature.

Methods: We recruited 588 subjects after MI and followed up their cases for up to 8 years. Patients underwent detailed assessments of cardiac status, conventional cardiac risk factors, and noncardiac illness at baseline. Depression was assessed for the period immediately preceding MI and at 12 months after MI, using a standardized questionnaire and a research interview. At follow-up, the mortality status, cause, and date of death were recorded for 587 subjects using population records.

Results: Multivariate predictors of cardiac death included older age (hazard ratio [HR] = 1.04, p = 0.007), previous angina (HR = 1.8, p = 0.03), previous MIs (HR = 1.6, p = 0.004), Killip class (HR = 1.8, p = 0.005), beta-blockers (HR = 0.5, p = 0.023), and angiotensin-converting enzyme inhibitors (HR = 0.6, p = 0.047) prescribed on discharge. Depression was not associated with cardiac mortality, whether detected immediately before MI (p = 0.48), 12 months after MI (p = 0.27), or at both time points (p = 0.97).

Conclusions: The association between depression and post-MI mortality is complex, possibly being limited to depression immediately after MI. Defining the window when intervention for depression might benefit survival is crucial for the design of future trials.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CABG = coronary artery bypass graft   CI = confidence interval   CPK = creatine phosphokinase   HADS = Hospital Anxiety and Depression Scale   MI = myocardial infarction

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				C. Dickens, B. Tomenson, and F. Creed Reply J. Am. Coll. Cardiol., October 9, 2007; 50(15): 1520 - 1520. [Full Text] [PDF]

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