The incidence, clinical significance of depression and its clinical course after a cardac device implantation in patients with severe heart failure

Abstract Aim To assess the incidence, clinical significance of depression and the impact of a cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) implantation on psychiatric status in patients with heart failure (HF). Methods The prospective, single-center study encompassed 575 consecutive HF patients implanted with a CRT-D or ICD. Finally, the study population consisted of 494 subjects (186 ICD and 308 CRT-D patients), as 81 patients taking antidepressants were excluded from the analysis. All patients underwent psychiatric examination at the time of implantation, and the assessment of psychiatric status was repeated after 3, 6, 12 and 24 months. The study population was divided into 4 groups: Group 1 encompassed 101 (20.4%) patients with persistent depression, Group 2 constituted of 95 (19.2%) patients with depression that developed after ICD/CRT-D implantation, whereas 43 (8.7%) patients with remission of depression comprised Group 3, and Group 4 encompassed 255 (51.6%) patients with never diagnosed depression. Data on long-term follow-up (median 34.1 months) were screened to identify patients who developed a composite endpoint defined as death or hospitalization for decompensated HF. Results The cumulative incidence of depression at the baseline assessment was 39.1%. Depression developed in 95 (27.1%) patients, whereas remission of depression was observed in 43 (29.9%) subjects after ICD/CRT-D implantation. ICD intervention (HR 3.3) and increase in NYHA class by at least one class (HR 2.6) were the independent risk factors for depression development, whereas mitral regurgitation reduction (HR 1.9), as well as improvement in NYHA class by at least one class (HR 2.4) were the independent predictors for depression remission. Patients with persistent depression (Group 1) and those with newly developed depression (Group 2) were at significantly higher risk of a composite endpoint compared to patients in Group 3 and Group 4 (Table 1). Conclusions Depression is a common comorbidity associated with HF, as it affects 4 of 10 HF patients. ICD intervention and HF worsening are the strongest predictors for depression development after ICD/CRT-D implantation. Depression is a strong, independent risk factor of poor outcomes in HF population. Funding Acknowledgement Type of funding source: None </jats:sec

P1762Prognostic significance of in-hospital incomplete and terminated revascularization in patients with acute myocardial infarction and without reduced left ventricle ejection fraction

Abstract Introduction In-hospital incomplete and terminated at discharge myocardial revascularization has significant impact on mortality after acute myocardial infarction (AMI), also in patients (pts) with reduced left ventricle ejection fraction (LVEF) ≤35%. However, subjects with LVEF &gt;35%, who are not candidates for implantable cardioverter defibrillators, are still at risk. Authors hypothesized, that in those pts, the prognosis could be related to completeness of revascularization. Purpose To evaluate the risk of death and major adverse cardiovascular events (MACE) among pts with AMI and LVEF&gt;35% in relation to myocardial revascularization status. Methods Single center prospective study encompassed 445-pts with AMI and LVEF&gt;35%, who were treated with percutaneous coronary intervention and who survived in-hospital period. Study population was divided into two groups: group 1. – 73-pts with in-hospital incomplete and terminated revascularization at discharge; group 2. – 372-pts with complete or incomplete revascularization, in whom scheduled procedures were planned and performed (either percutaneous or surgical). The incidence of death and MACE was compared between groups during mean follow-up of 47.5 months after AMI. MACE was defined as a composite of death, recurrent AMI, non-scheduled revascularization, acute heart failure, stroke. Independent predictors for death were identified with multivariate Cox-regression models and expressed as hazard ratio (HR) with 95% confidence interval (CI). Results Patients in group 1. had higher mortality rate than in group 2. (26.4% vs. 9.1%; p&lt;0.001) – figure 1. The difference in the incidence of MACE was higher in group 1. than in group 2. (59.7% vs. 28.2%; p&lt;0.001). The analysis of particular MACE showed, that in group 1. the incidence of recurrent AMI, non-scheduled revascularization and stroke was higher than in group 2. (17.8% vs. 8.9%; p=0.022, and 33.3% vs. 16.1%; p=0.001, and 6.8% vs. 2.4%; p=0.048, respectively). Independent risk factors for death were: age ≥65 years (HR: 4.2; CI: 2.1–8.0) and incomplete and terminated myocardial revascularization at hospital discharge (HR: 2.5; CI: 1.4–4.4). Conclusions After invasive treatment of AMI, the prognosis in patients with LVEF&gt;35% is related to revascularization status. In-hospital incomplete and terminated revascularization at discharge is an independent risk factor for death in this population. </jats:sec