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Subdepression in patients with prior myocardial infarction: association with clinical characteristics of chronic coronary artery disease and comorbidities
1Novosibirsk State Medical University - Novosibirsk - Russian Federation
2Regional Clinical Hospital - Tver - Russian Federation
Purpose. To assess the prevalence of subdepression in patients with prior myocardial infarction (MI) and associated clinical characteristics of chronic coronary artery disease. Material and methods. In outpatient clinic, 245 patients of both sexes aged 35-60 years with prior MI were interviewed for current symptoms and history, and examined for cardiac status (vital signs, ECG, Holter, echo, stress test), as well as for mood disorder with Zung questionnaire. Subdepression (SbD) was defined as 50-59 points at Zung’s scale. Patients with more serious mood disorders (60+ points) were excluded from analysis. Multiple clinical and instrumental factors were assessed: stable angina (SA) and its grade, chest pain (CP) of any type, symptoms of chronic cerebral ischemia (SCCI), symptoms of arrhythmia (SAr), symptoms of low limb ischemia (SLLI), time to prior MI (TMI), arterial hypertension (AH), obesity (Ob), family history of heart disease (FHHD), ventricular arrhythmias (VA), Q waves (QW) and ischemic ST depression (ISTD) on ECG and Holter, systolic and diastolic dysfunction (SDF, DDF) on echo, functional capacity (FC) in stress test. Univariate logistic regression analysis was done sequentially with SbD as dependent categorical variable and all mentioned factors to identify significant associations and select factors for further multivariate stepwise backward logistic regression analysis. Odds ratios (OR) were calculated from regression coefficients with 95% confidence intervals. Results. Overall SbD was found in 29 (22.8%) men and 42 (35.6%) women. In univariate analysis, OR of SbD for female sex was 2.2 (1.3-3.9), age >50 years – 2.8 (1.5-5.0), SA – 7.0 (2.4-20.5), CP – 9.2 (2.1-39.6), SCCI – 4.7 (2.2-10.3), TMI >1 year – 2.2 (1.3-4.0), FHHD – 2.1 (1.2-3.9), VA – 1.9 (1.1-3.4), ISTD – 2.3 (1.2-4.2), FC < 75 W – 4.8 (2.1-11.0). No statistically significant associations were found between SbD and SAr, SLLI, AH, Ob, QW, SDF, DDF. In multivariate model (overall accuracy 0.80, pseudo-R square by Neigelkerke 0.495), independent associations with SbD were confirmed for older age (OR 2.8; 1.5-5.2), presence of CP (OR 3.7; 1.1-12.4), low FC (OR 2.3; 1.1-4.6), TMI >1 year (OR 2.2; 1.1-4.2), presence of SCCI (OR 3.3; 1.4-7.7). Female sex was no longer a significant factor (OR 1.9; 0.5-7.2). Presence of any type CP, as well as low FC were more important factors than presence of SA and its grade. Conclusion. Special attention should be reasonably paid to SbD and its multiple associated and predisposing factors to improve medical care and potentially prevent the post-MI patients from overt depression.
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