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Depressive symptoms, functional measures and long-term outcomes of high-risk ST-elevated myocardial infarction patients treated by primary angioplasty

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Abstract

The presence of major depressive symptoms is usually considered a negative long-term prognostic factor after an acute myocardial infarction (AMI); however, most of the supporting research was conducted before the era of immediate reperfusion by percutaneous coronary intervention. The aims of this study are to evaluate if depression still retains long-term prognostic significance in our era of immediate coronary reperfusion, and to study possible correlations with clinical parameters of physical performance. In 184 patients with recent ST-elevated AMI (STEMI), treated by immediate reperfusion, moderate or severe depressive symptoms (evaluated by Beck Depression Inventory version I) were present in 10 % of cases. Physical performance was evaluated by two 6-min walk tests and by a symptom-limited cardiopulmonary exercise test: somatic/affective (but not cognitive/affective) symptoms of depression and perceived quality of life (evaluated by the EuroQoL questionnaire) are worse in patients with lower levels of physical performance. Follow-up was performed after a median of 29 months by means of telephone interviews; 32 major adverse cardiovascular events (MACE) occurred. The presence of three vessels disease and low left ventricle ejection fraction are correlated with a greater incidence of MACE; only somatic/affective (but not cognitive/affective) symptoms of depression correlate with long-term outcomes. In patients with recent STEMI treated by immediate reperfusion, somatic/affective but not cognitive/affective symptoms of depression show prognostic value on long-term MACE. Depression symptoms are not predictors “per se” of adverse prognosis, but seem to express an underlying worse cardiac efficiency, clinically reflected by poorer physical performance.

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Abbreviations

%-VO2 :

Percentage of expected peak oxygen uptake

6MWT:

6-min walk test

ACE:

Angiotensin converting enzyme

AMI:

Acute myocardial infarction

AT-II:

Angiotensin II receptor type 2

BDI-I:

Beck Depression Inventory, version 1

CABG:

Coronary artery bypass graft

CPET:

Cardio-pulmonary exercise test

CR:

Cardiac rehabilitation

ECG:

Electrocardiogram

EQ-5D-3L:

European QoL questionnaire 5D-3L

EQ-VS:

European QoL questionnaire Visual Scale

MACE:

Major adverse cardiovascular events

MRI:

Magnetic resonance imaging

PCI:

Percutaneous coronary intervention

peak-VO2 :

Peak oxygen uptake

QoL:

Quality of life

STEMI:

ST-elevated myocardial infarction

W-max:

Maximum sustained workload at CPET, in Watt

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Authors and Affiliations

  1. Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Via Codivilla, 1, 32043, Cortina d’Ampezzo, BL, Italy

    Leonida Compostella, Sonia Lorenzi, Nicola Russo, Tiziana Setzu & Fabio Bellotto

  2. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy

    Leonida Compostella, Nicola Russo, Elia Vettore, Giambattista Isabella, Giuseppe Tarantini, Sabino Iliceto & Fabio Bellotto

  3. Department of Medicine, School of Emergency Medicine, University of Padua, Padova, Italy

    Caterina Compostella

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  1. Leonida Compostella
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Correspondence to Leonida Compostella.

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This work was not supported by Grant.

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The authors declare that they have no conflict of interest.

Statement of human and animal rights

The research was conducted in accordance with the ethical guidelines of the 1975 Declaration of Helsinki. This study is part of a larger follow-up study on AMI patients admitted to CR; approval of the Provincial Ethics Committee (Provincial Directorate of Health, Belluno, Italy) was obtained for the main research.

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Informed consent was obtained by all participants involved in the study.

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Compostella, L., Lorenzi, S., Russo, N. et al. Depressive symptoms, functional measures and long-term outcomes of high-risk ST-elevated myocardial infarction patients treated by primary angioplasty. Intern Emerg Med 12, 31–43 (2017). https://doi.org/10.1007/s11739-016-1504-9

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