Abstract 9395: Depression and Disease Severity in Patients With Premature Acute Coronary Syndrome: Findings From the PRAXY Study

Abstract

Background: Some studies demonstrate that depression is a risk factor for adverse outcomes in patients with acute coronary disease (ACS). However, it remains unclear if this association is confounded by ACS severity. The association between depression and ACS severity in younger patients has not been assessed, and sex differences in this potential relationship are unknown. Objectives: To assess whether major depression and depressive symptoms were associated with ACS severity in premature ACS patients; and to assess potential sex differences in these relationships. Methods: We enrolled 1023 patients (55 years or less) with ACS from January 2009 to September 2012 through the GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-Premature Acute Coronary SYndrome) study. Patients hospitalized for premature ACS were recruited from 26 centres in Canada, the US, and Switzerland. Main Outcome Measures included left ventricular ejection fraction (LVEF), Killip class, cardiac troponin levels, and Global Registry of Acute Coronary Events (GRACE) score. Univariate and multivariate regressions adjusting for sociodemographic and clinical variables were computed. Interaction terms between sex and major depression/depressive symptoms were added to the models to assess sex differences in the relationship between depression and severity. Results: The sample comprised 302 (30%) women and 248 (25%) patients with major depression; the median age was 49 years. Univariate analyses revealed that major depression was associated with a higher probability of normal LVEF (OR=1.70, 95% CI: 1.51-1.97, p=0.03) and lower troponin-I levels (estimate= -4.04, 95% CI: -8.01- -0.06, p=0.05). After adjustment for sociodemographic and clinical characteristics, neither major depression nor depressive symptoms were associated with LVEF, Killip class, Troponin-I levels, or GRACE score. The interaction analyses also revealed no sex differences in these relationships. Conclusion: We did not identify any association between major depression or depressive symptoms and ACS severity. The increased risk of mortality and CVD events in depressed patients may be explained by other mechanisms.