LETTER TO THE EDITOR
Depression as another possibleexplanation for worse outcomesin myocardial infarction during off-hours
Donald C. Haas, MD, MPH*,
Karina W. Davidson, PhD* and
Thomas G. Pickering, MD, DPhil*
* The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
donald.haas{at}msnyuhealth.org
We read with great interest the findings of Henriques et al. (1) regarding worse clinical outcomes for acute myocardial infarction (MI) patients treated with primary angioplasty during off-hours. In their otherwise excellent study, the investigators failed to measure depression or to mention it as another possible reason for the increased rates of failed angioplasty and 30-day mortality observed in those patients presenting between the hours of 1800 and 0800. Depression is common among patients with coronary disease (2), and depressed patients are more likely to develop initial MI symptoms off-hours (3). Depressed patients admitted for MI are at significantly increased risk for mortality (2) and for repeat coronary revascularization (4). Moreover, depression is associated with perturbations of circadian rhythms in patients with and without coronary disease (5). Thus, in addition to the reasons offered by the investigators (1), depression may be another explanation for the worse outcomes observed in patients presenting off-hours.
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1. Zwolle Myocardial Infarction Study GroupHenriques JPS, Haasdijk AP, Zijlstra F. Outcome of primary angioplasty for acute myocardial infarction during routine duty hours versus during off-hours. J Am Coll Cardiol. 2003;41:2138–2142[Abstract/Free Full Text]
2. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and the implications for therapy. Circulation. 1999;99:2192–2217[Abstract/Free Full Text]
3. Carney RM, Freedland KE, Jaffe AS. Altered circadian pattern of acute myocardial infarction in patients with depression. Coron Artery Dis. 1991;2:61–65
4. Sullivan MD, LaCroix AZ, Spertus JA, Hecht J, Russo J. Depression predicts revascularization procedures for 5 years after coronary angiography. Psychosom Med. 2003;65:229–236[Abstract/Free Full Text]
5. Carney RM, Freedland KE, Jaffe AS. Insomnia and depression prior to myocardial infarction. Psychosom Med. 1990;52:603–609[Abstract/Free Full Text]
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