Assessing the Relationship between Depression and Severity of Coronary Artery Disease Open Access

Halista, Michael Mitchell (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/9880vr43b?locale=en
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Abstract

BACKGROUND: The diagnosis of coronary artery disease (CAD) relies on cardiac catheterization to identify occlusions in the arteries that bring blood to heart muscle. Such a test is conducted only if deemed necessary based on the patient's clinical presentation, particularly the severity of a patient's chest pain. Doctors often rely on self-reported patient data to determine the best course of action. The Seattle Angina Questionnaire (SAQ) is a self-reported score that quantifies the severity of a patient's chest pain. This study aimed to elucidate any interaction depression had on the reliability of the SAQ as a prognostic tool.

METHODS: Study participants were enrolled into the Emory University Cardiology Biobank if they were at the hospital for a coronary catheterization. An ROC curve was used to determine the usefulness of the SAQ as a prognostic tool to predict death or myocardial infarction. Univariate and multivariate analysis were performed using patient characteristics provided by an administered questionnaire to determine significant predictors of the primary outcomes. One-way ANOVA was utilized to identify disparities among patients with scores in the upper, middle, or lower tertile of reported SAQ scores. A Kaplan-Meier curve using a Youden's Index to stratify reported SAQ scores according to relative risk of adverse events was created to illustrate the utility of the SAQ as a prognostic tool.

RESULTS: 3915 patients were included in the study. The ROC curve demonstrated that the SAQ's "Quality of Life" was determined to be a statistically-significant predictor of patient outcome with regard to death or myocardial infarction (p= 0.002). Multivariate analysis also revealed the "Quality of Life" section to be a significant, independent predictor of the identified primary outcomes (p = 0.003). Depression, as scored by the Patient Health Questionnaire- 9 (PHQ-9) was not found to be a predictor of primary outcomes (p > 0.07). This study confirmed depression's significant correlation with the severity of a patient's chest pain (p<0.001).

CONCLUSIONS: The "Quality of Life" section of the SAQ is a significant, independent predictor of death or myocardial infarctions in patients suffering from CAD and retains its prognostic value despite its correlation with depressive symptoms.

Table of Contents

Table of Contents

Title Page……………………………………………………………………………………………………………………………………1

Introduction: Coronary Artery Disease……………………………………………………………………………………….2

Coronary Artery Disease: Treatment …………………………………………………………………………………………4

Angina as a Symptom and a Tool……………………………………………………………………………………………….5

Depression and Coronary Artery Disease…………………………………………………………………………………..5

Current Study…………………………………………………………………………………………………………………………….6

Materials and Methods: Cardiology Biobank……………………………………………………………………………..7

PHQ-9……………………………………………………………………………………………………………………………………..…8

Gensini Score……………………………………………………………………………………………………………………………..8

Seattle Angina Questionnaire…….………………………………………………………………………………………………9

Exclusion Criteria….……………………………………………………………………………………………………………………9

Data Analysis……..………………………………………………………………………………………………………………………9

Results: Patient Characteristics………..………………………………………………………………………………………10

ROC Analysis………………………………………………….…………………………………………………………………………11

Variables Linked to Death by Myocardial Infarction …………………………………………………………………11

Table 1: Participant characteristics…..………………………………………………………………………………………11

Figure 1: ROC Curve……… …………………………………………………………………………………………………………13

SAQ and Depression… ………………………………………………………………………………………………………………14

Table 2. Univariate and Multivariate Analysis….. ………………………………………………………………………15

Discussion…………………………………………………………..……………………………………………………………………18

Table 3. One-Way ANOVA with SAQ/ Characteristics…. ……………………………………………………………19

Figure 2. Kaplan Meier Survival Curve ………………………………………………………………………………………23

References ………………………………………………………………………………………………………………………………24

Acknowledgments……………………………………………………………………………………………………………………25

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