抑郁症对自发性冠状动脉夹层患者临床结果的影响：使用TriNetX研究网络的倾向匹配分析

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal Pub Date : 2025-09-15 DOI:10.1016/j.ahj.2025.07.037

Abena Korwaa Agyekum MD , Ekow Essien MD , Karldon Nwaezeapu MD , Godbless Ajenaghughrure MD , Nana Osei MD , Maureen Masara MD , Gloria Amoako MD , Esther Obeng-Danso MD , Inna Bukharovich , Suzette Graham-Hill MD

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引用次数: 0

摘要

背景：自发性冠状动脉夹层（SCAD）是无传统心血管危险因素的年轻女性发生急性冠状动脉综合征的主要原因。抑郁症在SCAD幸存者中很常见，但其对临床结果的影响尚不清楚。我们比较了伴有和不伴有抑郁的SCAD患者的死亡率、心血管事件和其他临床结果。方法采用TriNetX研究网络（130家医疗机构）进行回顾性队列研究。将伴有抑郁（F32、F32A、F33、F33.1）的SCAD患者（ICD-10 I25.42）与不伴有抑郁的SCAD患者进行比较。在对基线人口统计学和合并症进行倾向评分匹配后，对每组3247例患者进行分析。主要结局为全因死亡率。次要结局包括心力衰竭（HF）、心房颤动（AF）、心源性休克、脑血管疾病（CVD）、急性肾损伤（AKI）和起搏器植入。结果在倾向匹配的队列中（每组3247例患者），抑郁症与HF （16.8% vs 12.2%；风险比[RR] 1.376, 95% CI 1.191-1.591; p<0.001）、CVD （12.8% vs 9.9%; RR 1.287, 95% CI 1.104-1.501; p=0.001）、AKI （9.8% vs 5.5%; RR 1.768, 95% CI 1.453-2.152; p<0.001）和AF （7.0% vs 5.4%; RR 1.288, 95% CI 1.045-1.588; p=0.017）相关。两组在全因死亡率、心源性休克和起搏器植入方面无显著差异。结论在SCAD患者中，共病性抑郁与HF、CVD、AKI和AF等不良结局的风险显著升高相关。这些发现强调了在这一人群中进行心理健康筛查和心血管综合护理的重要性。

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Impact of Depression on Clinical Outcomes Among Spontaneous Coronary Artery Dissection Patients: A Propensity-Matched Analysis Using the TriNetX Research Network

Background

Spontaneous coronary artery dissection (SCAD) is a major cause of acute coronary syndrome in young women without traditional cardiovascular risk factors. Depression is common among SCAD survivors, but its impact on clinical outcomes is poorly understood. We compared mortality, cardiovascular events, and other clinical outcomes in SCAD patients with and without depression.

Methods

We conducted a retrospective cohort study using the TriNetX Research Network (130 healthcare organizations). SCAD patients (ICD-10 I25.42) with depression (F32, F32A, F33, and F33.1) were compared to those without. After propensity score matching for baseline demographics and comorbidities, 3,247 patients per group were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included heart failure (HF), atrial fibrillation (AF), cardiogenic shock, cerebrovascular disease (CVD), acute kidney injury (AKI), and pacemaker implantation.

Results

In propensity-matched cohorts (3,247 patients per group), depression was associated with increased risk of HF (16.8% vs 12.2%; risk ratio [RR] 1.376, 95% CI 1.191-1.591; p<0.001), CVD (12.8% vs 9.9%; RR 1.287, 95% CI 1.104-1.501; p=0.001), AKI (9.8% vs 5.5%; RR 1.768, 95% CI 1.453-2.152; p<0.001), and AF (7.0% vs 5.4%; RR 1.288, 95% CI 1.045-1.588; p=0.017). There was no significant difference in all-cause mortality, cardiogenic shock, and pacemaker implantation.

Conclusion

Among SCAD patients, comorbid depression is associated with significantly higher risk of adverse outcomes including HF, CVD, AKI and AF. These findings underscore the importance of mental health screening and integrated cardiovascular care in this population.

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.