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François Lespérance, MD; Nancy Frasure-Smith, PhD; Martin Juneau, MD; Pierre Théroux, MD

Arch Intern Med. 2000;160:1354-1360.

Background  Depression is common after acute myocardial infarction and is associated with an increased risk of mortality for at least 18 months. The prevalence and prognostic impact of depression in patients with unstable angina, who account for a substantial portion of acute coronary syndrome admissions, have not been examined.

Methods  Interviews were carried out in hospital with 430 patients with unstable angina who did not require coronary artery bypass surgery before hospital discharge. Depression was assessed using the 21-item self-report Beck Depression Inventory and was defined as a score of 10 or higher. The primary outcome was 1-year cardiac death or nonfatal myocardial infarction.

Results  The Beck Depression Inventory identified depression in 41.4% of patients. Depressed patients were more likely to experience cardiac death or nonfatal myocardial infarction than other patients (odds ratio, 4.68; 95% confidence interval, 1.94-11.27; P<.001). The impact of depression remained after controlling for other significant prognostic factors, including baseline electrocardiographic evidence of ischemia, left ventricular ejection fraction, and the number of diseased coronary vessels (adjusted odds ratio, 6.73; 95% confidence interval, 2.43-18.64; P<.001).

Conclusions  Depression is common following an episode of unstable angina and is associated with an increased risk of major cardiac events during the following year.

From the Research Center, Montreal Heart Institute (Drs Lespérance, Frasure-Smith, Juneau, and Théroux); Departments of Psychiatry (Drs Lespérance and Frasure-Smith) and Medicine (Drs Juneau and Théroux), University of Montreal; and Department of Psychiatry (Drs Lespérance and Frasure-Smith) and School of Nursing (Dr Frasure-Smith), McGill University; Montreal, Quebec.

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