The Relationship Between Depression, Severity Of Coronary Artery Lesion And Endothelial Dysfunction In Patients With Acute Coronary Syndrome

BackgroundWith the development of social science and technology,based on the reflection of modern medicine,�holistic medicine� and �biopsychosocial medical model�(BPS)began to attract people's concern and attention.The occurrence and development of coronary heart disease is not only associated with biological factors,but also have connection with anxiety,depression and other psychological problems.A number of research shows that depression can increased the morbidity of coronary heart disease,especially the acute coronary syndrome(ACS).And it can increase all causes mortality and adverse events in cardiovascular patients.Depression is independent risk factors for prognosis of acute coronary syndrome patients.The instability of plaque in acute coronary syndrome patients is closely related to levels of vascular endothelial dysfunction.ADMA,as a competitive inhibitor of nitric oxide synthase(NOS),induce to endothelial dysfunction,so as to accelerate the progression of atherosclerosis,affecting the prognosis of patients with ACS.ADMA is expected to be a new target for the prevention and treatment of early atherosclerosis.However,the correlation among the degree of depression,the severity of coronary artery disease and the level of serum ADMA in ACS patients has not been reported.Can depression aggravate endothelial dysfunction in patients with ACS? And the information about the short term prognosis of ACS patients with depression needs further study.ObjectiveTo investigate the relationship among the severity of depression,the severity of coronary artery lesion and endothelial dysfunction in patients with acute coronary syndrome,evaluate the short term prognosis of ACS with depression patients.Contribute to evaluate the condition of ACS with depression patients,to take early intervention measures,and toimprove the prognosis of ACS with depression patients.MethodsFrom December 2014 to June 2015,selected 108 patients who were diagnosed of acute coronary syndrome in the Department of Cardiology of Tai'an Central Hospital.According to the score of SDS scale(the critical value of 53),patients were divided into No depression group(n=53)and Depression group(n=55).Collect the general condition and the complete information of examination results.Two groups were underwent select coronary angiography,to evaluate with the severity of coronary artery lesion of two groups patients according to Gensini score.All the patients enrolled were tested approximately2 ml of venous blood,and then stored the blood in refrigerator,waiting for the other samples collected.Detect the serum ADMA to evaluate of endothelial function.Follow up and record of major adverse cardiac events at 3 months after discharge.Results1.The baseline demographic and clinical characteristics,including age,sex and body weight index,hypertension,diabetes,family history,smoking,were similar in No depression group and Depression group(P > 0.05).2.The level of hs-CRP and AST,the number of medication of glycoprotein IIb/IIIa receptor antagonist in Depression group was significantly greater compared with the No depression group(P<0.05).The other test items,the LVEF and the basic medication did not differ between the two groups(P>0.05).3.There were significant differences in Gensini score and serum ADMA level between the No depression group and Depression group(P<0.05).Based on the degree of depression,the Depression group was divided into the mild,moderate and severe sub-groups.The difference of Gensini score and ADMA level in three sub-groups were statistically significant(P<0.05).4.There was no significant difference in the number and distribution of coronary artery lesions among the mild,moderate and severe sub-groups(P<0.05).5.SDS score was not correlated with age,BMI,TC,LDL-C.But the SDS score was positively correlated with the hs-CRP(r=0.16),AST(r=0.20),Gensini score(r=0.49),ADMA level(r=0.23).6.The rate of mortality,readmission,myocardial infarction reoccurring after three months of discharge is significant difference among the mild,moderate and severe sub-groups(P<0.05).Conclusions1.Depression in patients with acute coronary syndrome can aggravate the severity of coronary artery lesion,and the degree of depression is positively correlated with the severity of coronary artery lesion.2.The endothelial function will be affected in the ACS with depression patients,and the more severe the degree of depression,the more serious the degree of endothelial dysfunction.3.Depression affects short-term prognosis in ACS patients.