Depression and 1-year prognosis in unstable angina

Background: Depression is common after acute myocardial infarction and is a ssociated with an increased risk of mortality for at least 18 months. The p revalence and prognostic impact of depression in patients with unstable ang ina, who account for a substantial portion of acute coronary syndrome admis sions, have not been examined. Methods: Interviews were carried out in hospital with 430 patients with uns table angina who did not require coronary artery bypass surgery before hosp ital discharge. Depression was assessed using the 21-item self-report Beck Depression Inventory and was defined as a score of 10 or higher. The primar y outcome was 1-year cardiac death or nonfatal myocardial infarction. Results: The Beck Depression Inventory identified depression in 41.4% of pa tients. Depressed patients were more likely to experience cardiac death or nonfatal myocardial infarction than other patients (odds ratio, 4.68; 95% c onfidence interval, 1.9-11.27; P<.001). The impact of depression remained a fter controlling for other significant prognostic factors, including baseli ne electrocardiographic evidence of ischemia, left ventricular ejection fra ction, 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 a nd is associated with an increased risk of major cardiac events during the following year.