Frequency and clinical correlates of bipolar features in acute coronary syndrome patients.
BACKGROUND
Depression and acute coronary syndrome (ACS) are both extremely prevalent diseases. Studies aimed at evaluating whether depression is an independent risk factor for cardiac events provided no definitive results. In most of these studies, depression has been broadly defined with no differentiation between unipolar (MDD) versus bipolar forms (BD). The aim of this study was to evaluate the frequency of DSM-IV BD (bipolar I and bipolar II subtypes, cyclothymia), as well as temperamental or isolated bipolar features in a sample of 171 patients hospitalized for ACS. We also explored whether these psychopathological conditions were associated with some clinical characteristics of ACS.


METHODS
Patients with ACS admitted to three neighboring Cardiac Intensive Care Units (CICUs) in a 12-month continuative period of time were eligible for inclusion if they met the criteria for either acute myocardial infarct with or without ST-segment elevation or unstable angina, verified by standard ACS criteria. All patients underwent standardized cardiological and psychopathological evaluations.


RESULTS
Of the 171 ACS patients enrolled, 37 patients (21.7%) were found to have a DSM-IV mood disorder. Of these, 20 (11.7%) had bipolar type I or type II or cyclothymia, while 17 (10%) were the cases of MDD. Rapid mood switches ranged from 11% of ACS patients with no mood disorders, to 47% of those with MDD to 55% of those with BD. Linear regression analysis showed that a diagnosis of BD (p=.023), but not that of MDD (p=.721), was associated with a significant younger age at the index episode of ACS. A history of previous coronary events was more frequent in ACS patients with BD than in those with MDD.


CONCLUSIONS
Our data indicate that bipolar features and diagnosis are frequent in ACS patients. Bipolar disorder has a negative impact on cardiac symptomatology. Further research in this area is warranted.
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy. Electronic address: stefano.pini@med.unipi.it.
S
S
Pini
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy.
M
M
Abelli
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy.
C
C
Gesi
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy.
L
L
Lari
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy.
A
A
Cardini
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy.
L
L
Di Paolo
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy.
F
F
Felice
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy.
R
R
Di Stefano
Coronary Care Unit, Ospedale S. Andrea, La Spezia, Italy.
G
G
Mazzotta
Coronary Care Unit, Ospedale S. Andrea, La Spezia, Italy.
C
C
Oligeri
Coronary Care Unit, USL 2, Lucca, Italy.
F M
FM
Bovenzi
Coronary Care Unit, USL 2, Lucca, Italy.
L
L
Borelli
Complex Care and Rehabilitating Unit of Cardiology, USL5 Sarzana (SP), Italy.
D
D
Bertoli
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy.
P
P
Michi
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy.
A
A
Muccignat
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy.
J
J
Micchi
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy.
A
A
Balbarini
D054058:Acute Coronary Syndrome / Q000453:epidemiology*; D001714:Bipolar Disorder / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors
Acute coronary syndrome; Bipolar disorder; Bipolar features; Depression; Mania