Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study.
BACKGROUND
The association of depression with cardiac events has been investigated mainly in community cohorts, in patients undergoing catheterisation, or in patients who have had myocardial infarction. We have assessed the effect of depression on outcomes after coronary artery bypass graft (CABG) surgery.


METHODS
In a prospective study, we followed up for 1 year 207 men and 102 women, who had undergone coronary artery bypass graft surgery. We assessed depression with a structured psychiatric interview (diagnostic interview schedule) and a questionnaire (Beck depression inventory) before discharge. Cardiac events included angina or heart failure that needed admission to hospital, myocardial infarction, cardiac arrest, percutaneous transluminal coronary angioplasty, repeat CABG, and cardiac mortality. Non-cardiac events consisted of all other reasons for mortality or readmission.


RESULTS
63 patients (20%) met modified diagnostic statistical manual IV criteria for major depressive disorder. At 12 months, 17 (27%) of these patients had a cardiac event compared with 25 of 246 (10%) who were not depressed (p<0.0008). Five variables had significant univariate associations with cardiac events: sex, living alone, low ejection fraction (<0.35), length of hospital stay, and depression. In a Cox proportional-hazard model with these five and two other variables of cardiac severity, major depressive disorder (risk ratio 2.3 [95% CI 1.17-4.56]), low ejection fraction (2.3 [1.07-5.03]), and female sex (2.4 [1.24-4.44]) were associated with adverse outcomes. Depression did not predict deaths or admissions for non-cardiac events.


CONCLUSIONS
Depression is an important independent risk factor for cardiac events after CABG surgery.
Connerney
I
I
Mailman School of Public Health, Columbia University, New York, NY, USA. iconnerney@umm.edu
Shapiro
P A
PA
McLaughlin
J S
JS
Bagiella
E
E
Sloan
R P
RP
D017677:Age Distribution; D000368:Aged; D001026:Coronary Artery Bypass; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006304:Health Status; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011581:Psychological Tests; D017678:Sex Distribution; D013997:Time Factors