13th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 1998

January 24-31, 1998
Marilleva, Trento, Italy

RT-169

Depression in post-myocardial infarction patients: a new risk factor for sudden death?

Maria Vittoria Pitzalis, Luana Ligurgo, Andrea Passantino§, Orlando Todarello*, Giovanni Dello Russo*, Paolo Rizzon.
Institute of Cardiology, University of Bari, §Division of Cardiology, "S. Maugeri" Foundation IRCCS, Cassano Murge, Bari, *Institute of Psychiatry II, University of Bari, Italy

Introduction

Several studies have hypothesized a relationship between sudden death and neurophysiologic factors. In particular, it has been suggested a complex interrelationship between emotional disturbances (and in particular, depression) and cardiovascular mortality in patients who survived an acute myocardial infarction.

The appearance of psychologic abnormalities in patients who survived a myocardial infarction is quite frequent¹, depressive symptoms being present in 20-30%^2-4. Depression in patients with coronary artery disease remains stable over time^5-8 and do not seem to correlate with the severity of cardiac disease^1,3. In 1969, Wolf described the possibility of predicting death in 10 patients who survived myocardial infarction by using psychological tests⁹. Since then, several studies have been drawn up in order to test the prognostic relevance of depression and cognitive impairment in post-myocardial infarction patients^4,10. A CAPS substudy suggested that patients at higher risk for mortality and cardiac arrest are not those who appear ambitious, hard driving or engaged in activities (global type A) but rather those who are withdrawn from life's challenges and opportunities¹¹. Additionally, patients showing depressive symptoms were characterized by the highest incidence of mortality and/or cardiac arrest^12,13. Another multicenter study¹⁴ confirmed the predictive value of depression and showed that depressive symptoms are more prevalent in lower social classes and in patients with lower education, thus underlying the role of socio-economic and psycho-social status in predicting prognosis in post-myocardial infarction patients. Those patients living alone after myocardial infarction have a high incidence of cardiac events during the first six months from the acute event¹⁵. Two recent studies^16,17 have shown that depressive signs during the acute phase of myocardial infarction are associated with an increase in cardiac mortality. Depression is a prognostic index which is independent from traditional risk factors. The risk is particularly high in those patients who show frequent premature ventricular contractions (> 10 PVCs/h).