To the Editor:
I read the article by Herbison et al.
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The authors conducted a follow-up study for participants with acute coronary syndrome, and a total of 52 patients died. The Beck Depression Inventory-II, especially 2 components of the Beck Depression Inventory-II, such as somatic and cognitive elements, was used for the analysis. Although statistical significance was not observed, the authors concluded that a higher baseline Beck Depression Inventory-II score, particularly somatic score, showed a risk of all-cause mortality in patients with acute coronary syndrome. I present some concerns about their study.First, the authors recognized the limitation of sample size, which would affect the model stability. In contrast, they mentioned that there was an advantage of using the Global Registry of Acute Coronary Events score for the statistical adjustment. Roest et al
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conducted a 12-month follow-up study to know the effect of depression on all-cause mortality in patients with acute coronary syndrome, and 51 patients died. The adjusted odds ratio of the somatic/affective component of the Beck Depression Inventory for mortality was 1.92 (95% confidence interval, 1.36-2.71) by logistic regression analysis. In contrast, there was no significant effect of the cognitive/affective component of the Beck Depression Inventory on mortality. The number of events was almost the same, and the risk of somatic score of the Beck Depression Inventory for all-cause mortality was in concordance with the study by Herbison et al.1
I recommend citing this study for their study.Second, the authors cited a study by Meurs et al.
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They also used the Global Registry of Acute Coronary Events score as an adjustment of depression for events, but they handled cardiovascular events, including nonfatal cases. Although somatic and affective depressive symptoms were selected as a significant predictor for events, the meanings of the Global Registry of Acute Coronary Events score for cause-specific events and all-cause mortality should be handled with caution in patients with acute coronary syndrome.Finally, the authors cited studies on the time of depression in patients with acute coronary syndrome,
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which was associated with subsequent mortality. These references also handled different events, such as all-cause mortality and cardiac events. The content of events is important for the risk assessment of depression, and a stratified analysis with a sufficient number of events is desirable in future study.References
- Components of depression and 6-year mortality after an acute coronary syndrome.Am J Med. 2015; 128: 540.e1-540.e6
- Somatic/affective symptoms, but not cognitive/affective symptoms, of depression after acute coronary syndrome are associated with 12-month all-cause mortality.J Affect Disord. 2011; 131: 158-163
- Examining the relation between post myocardial infarction depression and cardiovascular prognosis using a validated prediction model for post myocardial mortality.Int J Cardiol. 2013; 167: 2533-2538
- Effect of depression on five-year mortality after an acute coronary syndrome.Am J Cardiol. 2005; 96: 1179-1185
- Specificity of depression following an acute coronary syndrome to an adverse outcome extends over five years.Psychiatry Res. 2011; 185: 347-352
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Funding: None.
Conflict of Interest: None.
Authorship: The author had access to the data and played a role in writing this manuscript.
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© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Components of Depression and 6-Year Mortality After an Acute Coronary SyndromeThe American Journal of MedicineVol. 128Issue 5
- The ReplyThe American Journal of MedicineVol. 129Issue 1
- PreviewThank you for taking an interest in our paper1 and for drawing our attention to the paper by Roest et al.2 There are several reasons why their answer may differ from ours. These include chance, having a 1-year follow-up rather than 6 years, and potentially overfitting their analysis model. They had 51 deaths and fitted a model using 7 degrees of freedom (the rule of thumb is 10 events per degree of freedom), which can lead to instability of the estimates. Using the Global Registry of Acute Coronary Events (GRACE) score should adjust for the severity of the acute coronary syndrome, using only 1 degree of freedom.
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