Relations among depressive symptoms, electrocardiographic hypertrophy, and cardiac events in non-ST elevation acute coronary syndrome patients

Abstract

Cardiac outcomes after acute coronary syndrome (ACS) are worse in patients with depression, but identifying which depressed patients are at increased risk, and by what means, remains difficult. We analyzed inpatient electrocardiograms (ECGs) from 955 patients admitted with non-ST elevation ACS (NSTE-ACS) in the Prescription Use, Lifestyle, and Stress Evaluation (PULSE) study. Patients with QRS duration ⩾120 ms or whose rhythm was not normal sinus were excluded (sample size=769). Depressive symptoms were measured by Beck Depression Inventory score ⩾10. ECG markers included Cornell product-left ventricular hypertrophy (CP-LVH) and strain pattern in the lateral leads. In multivariable logistic regression models, depressive symptoms were associated with increased odds of CP-LVH, ECG-strain, and the combination of the two (odds ratios 1.74-2.33, p values <0.01). The combination of both CP-LVH and ECG-strain was predictive of one-year risk of myocardial infarction (MI) or death among patients with depressive symptoms (hazard ratio 4.91, 95% CI 1.55-15.61, p=0.007), but not among those without depressive symptoms (p value for interaction 0.043). In our non-ST elevation (NSTE)-ACS cohort, ECG markers of hypertrophy were both more common, and more predictive of MI/mortality, among those with depressive symptoms. Cardiac hypertrophy is a potential target for therapy to improve outcomes among depressed NSTE-ACS patients.