Depression and myocardial injury in ST-segment elevation myocardial infarction: A cardiac magnetic resonance imaging study

Table 1 Baseline characteristics of the patients by Patient Health Questionnaire-9 score

Variables	Overall (n = 107)	PHQ-9 score < 10 (n = 88)	PHQ-9 score ≥ 10 (n = 19)	P value
Demographics
Age, yr	56.5 ± 10.5	56.2 ± 10.7	58.1 ± 9.8	0.469
Male	86 (80.4)	71 (80.7)	15 (78.9)	0.863
Medical history
History of diabetes mellitus	29 (27.1)	23 (26.1)	6 (31.6)	0.628
History of hypertension	44 (41.1)	34 (38.6)	10 (52.6)	0.261
History of cerebrovascular disease	12 (11.2)	11 (12.5)	1 (5.3)	0.365
Prior PCI	3 (2.8)	2 (2.3)	1 (5.3)	0.474
Current smoking	74 (69.2)	61 (69.3)	13 (68.4)	0.939
Clinical presentation
PHQ-9 score	4.9 ± 5.1	2.9 ± 2.6	14.3 ± 2.8	≤ 0.001
SBP on admission, mmHg	125.9 ± 23.8	125.7 ± 22.4	127.0 ± 30.1	0.823
Heart rate on admission, bpm	78.9 ± 17.2	77.3 ± 17.1	86.4 ± 16.0	0.037
Laboratory results on admission
Troponin-I, ng/mL	27.0 (8.6, 58.5)	24.7 (9.0, 56.6)	32.8 (3.5, 80.0)	0.504
Creatinine, µmol/l	70.2 ± 16.3	67.9 ± 14.8	80.8 ± 18.9	0.002
Albumin, g/L	40.5 ± 3.3	40.4 ± 3.2	40.7 ± 4.2	0.789
Hemoglobin, g/L	139.9 ± 22.5	139.6 ± 22.8	141.6 ± 21.5	0.723
Fasting glucose, mmol/L	7.38 ± 2.92	7.37 ± 2.96	7.43 ± 2.83	0.936
BNP, ng/L	111 (58, 239)	107 (58, 232)	180 (53, 473)	0.293
Total cholesterol, mmol/L	4.83 ± 1.13	4.73 ± 1.14	5.31 ± 0.99	0.041
Low-density lipoprotein, mmol/L	3.07 ± 1.00	2.99 ± 1.00	3.43 ± 0.93	0.08
High-density lipoprotein, mmol/L	0.99 ± 0.26	0.97 ± 0.26	1.07 ± 0.27	0.137
Triglycerides, mmol/L	1.46 (0.99, 2.26)	1.46 (0.99, 2.21)	1.47 (0.60, 3.29)	0.929
Percutaneous coronary intervention details
Door-to-balloon time, min	80.0 (50.0, 120.0)	81.5 (49.9, 127.8)	67.3 (50.0, 103.0)	0.52
Culprit vessels				0.294
Right coronary artery	52 (48.6)	45 (51.1)	7 (36.8)
Left anterior descending artery	45 (42.1)	34 (38.6)	11 (57.9)
Left circumflex artery	10 (9.3)	9 (10.2)	1 (5.3)
Use of intra-aortic balloon pump	3 (2.8)	1 (1.1)	2 (10.5)	0.025
Killip class I on admission	95 (88.8)	80 (90.9)	15 (78.9)	0.134
TIMI flow grade 3 post-PCI	105 (98.1)	86 (97.7)	19 (100)	0.507

Data are presented as median (IQR), n (%), or mean ± SD.PHQ-9: Patient Health Questionnaire-9; PCI: Percutaneous coronary intervention; SBP: Systolic blood pressure; bpm: Beats per minute; BNP: Brain natriuretic peptide.

Table 2 Cardiac magnetic resonance characteristics of the patients by Patient Health Questionnaire-9score

Variable	Overall (n = 107)	PHQ-9 score < 10 (n = 88)	PHQ-9 score ≥ 10 (n = 19)	P value
LVEDV, mL/m2	132.7 ± 27.5	132.6 ± 23.3	133.4 ± 42.8	0.906
LVESV, mL/m2	69.8 ± 27.1	67.9 ± 22.8	78.5 ± 41.6	0.123
SV, mL/m2	62.7 ± 15.3	64.4 ± 14.7	54.9 ± 16.2	0.014
LVEF, %	48.5 ± 12.3	49.6 ± 11.5	43.7 ± 14.8	0.059
AAR, %	33.7 ± 11.7	32.5 ± 11.2	39.3 ± 12.7	0.023
IS, %	15.40 ± 10.12	13.92 ± 7.61	22.24 ± 16.20	0.001
MVO	52 (48.6)	45 (51.1)	7 (36.8)	0.258
IMH	35 (32.7)	29 (33.0)	6 (31.6)	0.908
MSI, %	55.8 ± 26.4	57.3 ± 24.8	49.2 ± 32.9	0.227

Data are presented as median (IQR), n (%), or mean ± SD.CMR: Cardiac magnetic resonance; PHQ-9: Patient Health Questionnaire-9; LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; SV: Stroke volume; LVEF:Left ventricular ejection fraction; AAR: Area at risk; IS: Infarction size; MVO: Microvascular obstruction; IMH: Intramyocardial hemorrhage; MSI: Myocardial salvage index.

Table 3 Effects of Patient Health Questionnaire-9 on large infarction size in the univariate and multivariate analyses

	Univariate analysis			Multivariate analysis
	OR	95%CI	P value	OR	95%CI	P value
PHQ-9 as a continuous variable
PHQ-9 score, per 1 unit increase	1.191	1.087-1.305	≤ 0.001	1.226	1.073-1.401	0.0031
PHQ-9 as a categorical variable
PHQ-9 ≥ 10	4.38	1.520-12.619	0.006	4.84	1.122-20.868	0.0341

¹Adjusted for Troponin-I, high-density lipoprotein, door-to-balloon time, culprit vessels, stroke volume, left ventricular ejection fraction, area at risk, microvascular obstruction, intramyocardial hemorrhageand myocardial salvage index.PHQ-9: Patient Health Questionnaire-9.

Table 4 Correlation between Patient Health Questionnaire-9 score and myocardial injury variables measured on cardiac magnetic resonance

	Correlation coefficient	P value
AAR	0.278	0.004
IS	0.39	≤ 0.001
MVO	0.038	0.699
IMH	0.026	0.793
MSI	-0.152	0.118

PHQ-9: Patient Health Questionnaire-9; AAR: Area at risk; IS: Infarction size; MVO: Microvascular obstruction; IMH: Intramyocardial hemorrhage; MSI: Myocardial salvage index.