Myocardial infarction: post-infarction depression increased the risk of dying

Clinical bottom line (level 1b)

  1. One in four patients who survive a myocardial infarction died within 10 years, and one in five had a recurrent myocardial infarction.
  2. The risk of dying was increased with
    • left ventricular failure
    • ventricular arrhythmias
    • depression after infarction
Welin et al: J Intern Med 2000; 247 : 629-639
Expires February 2004

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: community, Sweden

275 patients (aged , 84% male) survived for 3 months following a myocardial infarction (diagnosed using WHO criteria)

Excluded if
  • aged > 65



Multivariate Cox regression analyses were used to adjust for confounding factors.

100% followed for 10 years
Outcomes studied:
  • death
  • recurrent myocardial infarction

The evidence

outcome time to outcome number of patients/total number %
(95% CI)		 NNF
(95% CI)
death 10 years 67/275 24%
(19% to 29%)		 4
(3 to 5)
recurrent myocardial infarction 10 years 55/275 20%
(15% to 25%)		 5
(4 to 7)

prognostic factor for
death 		time to outcome adjusted RR
(95% CI)		 NNF+
(95% CI)
left ventricular failure 10 years 2.90
(1.70 to 4.95) 		9
(4 to 23)
ventricular dysrhythmia 10 years 2.49
(1.09 to 5.67) 		13
(4 to 210)
depression after infarction 10 years 1.75
(1.02 to 2.99) 		19
(7 to 700)

 

    Citation

     

    1. Welin C, Lappas G, Wilhelmsen L: independent importance of psychosocial factors for prognosis after myocardial infarction. J Intern Med 2000; 247 : 629-639
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, February 2002
    Reviewer:

    Clinical Question.
    Patient recent myocardial infarction
    Intervention or Exposure psychosocial factors
    Outcome death