Depression and risk of stroke and mortality after percutaneous coronary intervention: A nationwide population study

IF 9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Internal Medicine Pub Date : 2024-10-06 DOI:10.1111/joim.20018

Dae Young Cheon, Yong-Moon Park, Myung Soo Park, Jae Hyuk Choi, Mi-Sun Oh, Seongwoo Han, Kyung-Ho Yu, Byung-Chul Lee, Kyungdo Han, Minwoo Lee

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引用次数: 0

Abstract

Background

Limited evidence exists on the role of depression in the risk of developing stroke and other cardiovascular outcomes in patients who have undergone percutaneous coronary interventions (PCI). We investigated this relationship with data from the Korean National Health Insurance Service database.

Methods

Our nationwide retrospective cohort study included 164,198 patients who had undergone PCI between 2010 and 2017. Depression was defined with the ICD-10 codes recorded prior to the PCI. The primary outcome was a new-onset stroke following the PCI. Secondary outcomes included PCI with myocardial infarction (MI), revascularization (PCI or coronary artery bypass grafting), and all-cause mortality. A multivariable Cox proportional hazards regression analysis was used to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI), adjusting for potential confounders, including sociodemographic and lifestyle factors, comorbidities, and MI at the index PCI.

Results

Over a median follow-up of 5.0 years, acute stroke occurred in 5.7% of patients with pre-existing depression (17.4% of the study population), compared to 3.5% of those without depression. Depression was associated with a 27% increased risk of acute stroke (aHR 1.27, 95% CI 1.20–1.35). Additionally, depression was linked with a 25% elevated risk of all-cause death (aHR 1.25, 95% CI, 1.21–1.29) and an 8% increased risk of revascularization (aHR 1.08, 95% CI 1.04–1.11). The associations with the risk of stroke and all-cause mortality were stronger in patients under 65 years.

Conclusions

Our findings suggest that pre-existing depression may increase the risk of stroke and all-cause mortality following PCI, particularly in patients under 65 years. Additionally, depression was significantly associated with an increased need for revascularization. This underscores the potential benefits of managing depression to reduce stroke risk and overall cardiovascular outcomes following PCI.

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查看原文本刊更多论文

抑郁与经皮冠状动脉介入治疗后的中风和死亡风险：一项全国性人口研究。

背景：关于抑郁症在经皮冠状动脉介入治疗（PCI）患者发生中风和其他心血管疾病风险中的作用，目前证据有限。我们利用韩国国民健康保险服务数据库的数据研究了这种关系：我们的全国性回顾性队列研究纳入了 164198 名在 2010 年至 2017 年间接受过 PCI 的患者。抑郁症是根据 PCI 之前记录的 ICD-10 代码定义的。主要结果是PCI术后新发中风。次要结局包括 PCI 并发心肌梗死（MI）、血管再通术（PCI 或冠状动脉旁路移植术）和全因死亡率。采用多变量考克斯比例危险回归分析计算调整后的危险比（aHR）和95%置信区间（CI），并调整潜在的混杂因素，包括社会人口学和生活方式因素、合并症和指数PCI时的心肌梗死：在中位随访 5.0 年期间，5.7% 的原有抑郁症患者（占研究人群的 17.4%）发生了急性脑卒中，而无抑郁症患者仅为 3.5%。抑郁症导致急性中风风险增加 27%（aHR 1.27，95% CI 1.20-1.35）。此外，抑郁症还导致全因死亡风险增加 25%（aHR 1.25，95% CI，1.21-1.29），血管再通风险增加 8%（aHR 1.08，95% CI 1.04-1.11）。65岁以下患者的中风风险和全因死亡率的相关性更强：我们的研究结果表明，原有抑郁可能会增加PCI术后中风和全因死亡的风险，尤其是65岁以下的患者。此外，抑郁症还与血管重建需求的增加密切相关。这强调了管理抑郁症对降低PCI术后中风风险和整体心血管预后的潜在益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Internal Medicine 医学-医学：内科

CiteScore

22.00

自引率

0.90%

发文量

176

审稿时长

4-8 weeks

期刊介绍： JIM – The Journal of Internal Medicine, in continuous publication since 1863, is an international, peer-reviewed scientific journal. It publishes original work in clinical science, spanning from bench to bedside, encompassing a wide range of internal medicine and its subspecialties. JIM showcases original articles, reviews, brief reports, and research letters in the field of internal medicine.