Clinical features of coronary artery disease and 5-year survival of patients after myocardial infarction against the background of depressive disorders

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Abstract

Aim. To assess the features of the clinical picture of coronary artery disease (CAD) and the prognosis of patients with myocardial infarction with depressive disorder (DD).

Materials and methods. We examined 101 patients with stable CAD who had myocardial infarction more than six months ago: 67 CAD patients with depression (Group 1) and 34 CAD patients without depression (Group 2). The clinical picture of CAD was assessed by complaints, angina self-monitoring diaries, and exercise tests. The presence and severity of DD was determined using psychometric scales: BDI (Beck Depression Scale), HADS (Hospital Anxiety and Depression Scale) and the opinion of a psychiatrist. Five-year survival information was obtained through telephone interviews with patients and their relatives.

Results. In patients with CAD and DD in comparison with patients without DD self-monitoring diaries revealed more frequent angina attacks: 9 [6; 12] vs 6 [4; 7] per week (p=0.0001), the greater need for sublingual nitrates: 2 [0; 9] pills vs 0 [0; 4] pills (p=0.0001). DD significantly reduced exercise tolerance: 370 [250; 450] meters vs 435 [350; 500] meters using the six-minute walk test (p=0.04), according to the results of bicycle ergometry – 50 [25; 75] W vs 75 [50; 75] W (p=0.03). After 5 years of follow-up patients with comorbidities (CAD and DD) had a greater number of deaths: 13 (19.4%) vs 2 (5.9%), respectively, survived – 54 (80.6%) vs 32 (94.1%) (Gehan–Wilcoxon test, p=0.04).

Conclusion. The comorbidity CAD and DD leads to a worsening of the clinical course of CAD and prognosis, which actualizes the need for verification of the diagnosis of DD and timely prescription of antidepressant therapy.

About the authors

Tatiana G. Nonka

Tomsk National Research Medical Center of the Russian Academy of Sciences

Author for correspondence.
Email: tatiananonka@gmail.com
ORCID iD: 0000-0002-7913-3732

кандидат медицинских наук, научный сотрудник отделения общеклинической кардиологии и эпидемиологии сердечно-сосудистых заболеваний Научно-исследовательского института кардиологии

Russian Federation, Tomsk

Elena V. Lebedeva

Tomsk National Research Medical Center of the Russian Academy of Sciences

Email: tatiananonka@gmail.com
ORCID iD: 0000-0001-6117-6454

доктор медицинских наук, научный сотрудник отделения общеклинической кардиологии и эпидемиологии сердечно-сосудистых заболеваний Научно-исследовательского института кардиологии, ст. научный сотрудник отделения аффективных состояний Научно-исследовательского института психического здоровья

Russian Federation, Tomsk

Alexey N. Repin

Tomsk National Research Medical Center of the Russian Academy of Sciences

Email: tatiananonka@gmail.com
ORCID iD: 0000-0001-7123-0645

доктор медицинских наук, профессор, рук. отделения общеклинической кардиологии и эпидемиологии сердечно-сосудистых заболеваний Научно-исследовательского института кардиологии

Russian Federation, Tomsk

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2. Fig. 1. Analysis of Kaplan–Meier survival in coronary artery disease patients with depressive disorder (1) compared with coronary artery disease patients without depressive disorder (2).

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