The Study On The Depression’s Long-term Impact On Patients With CHD Undergoing Coronary Revascularization

Background and objectives:Coronary heart disease (CHD) is one of the common clinical heart diseases and badly harmful to human health. With the high incidence of CHD and the development of surgery, the treatment methods developed from the single-drug therapy to percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).Former studies reported that CABG patients would get depression, and depression was an independent risk factor for coronary heart disease. Depression will not only increase the incidence of CHD, but also was independently correlated with recurrence of myocardial ischemia, acute myocardial infarction, congestive heart failure or arrhythmias and other cardiovascular events. At present, few reports were retrieved about the influence of depression on coronary heart disease revascularization long-term prognosis. Therefore, we investigated the incidence of depression before and after CABG surgery in CHD patients and the influence on long-term prognosis so as to propose a reference for the combined treatment of psychological interventions in CHD patients with depression undergoing CABG.Methods:CHD patients treat with CABG were divided into depression and non-depression groups based on ZUNG serf-rating depression scale (SDS).The prevalence and degree of depression before and after surgery were compared. Both two groups patients were followed up for24months after procedure and the occurrence of major adverse cardiovascular events (MACE) were recorded. Survival analysis and Cox regression were used to detect risk factors correlated with MACE.Results:(1) The proportion of female, history of hypertension and cerebrovascular disease and BMI (body mass index) were significantly different between the two groups (P<0.05).(2)The prevalence of depression before CABG was significantly lower than after CABG (27.2%vs39.4%, P<0.05).(3) The total incidence of MACE in depression group was significantly higher than the non-depression group24months later. The incidences of myocardial infarction and revascularization in depression group were significantly higher than non-depression group (8.3%vs2.6%,8.3%vs1.6%, P<0.05).No significance was found in accumulative mortality between two groups(3.3%vs1.6%, P=0.315).(4) The survival curve of Kaplan- Meier show that the survival rate of non MACE in depression patients was significantly lower than depression patients than non-depression patients(P<0.001) while there was no significant difference on death survival analysis(P=0.309).(5) Depression, myocardial infarction and low LVEF (left ventricular ejection fraction) were independent risk factors for MACE(Depression HR6.37,95%CI:1.12～22.45, P=0.009).Conclusion:High proportion of patients with varying degrees of depression were found before and after coronary artery bypass grafting surgery, and the prevalence of depression in postoperative patients was significantly higher than before. The depression group got a higher incidence of MACE than non-depression after CABG. Being depression after CABG is an independent risk factor for MACE after CABG destructive to long-term prognosis.