Trends and Outcomes of Coronary Artery Bypass Grafting in Patients with Major Depressive Disorder

Abstract

Purpose: Coronary artery disease is a major cause of morbidity and mortality in the United States, representing the highest proportion of deaths due to cardiovascular disease. Treatment of coronary artery disease ranges from prevention to intervention, with the latter warranting a decision between surgical versus percutaneous revascularization. Medical optimization before coronary artery bypass grafting (CABG) is an important step in the care continuum. While the optimization of many risk factors such as smoking has been studied extensively, the inclusion of mental health conditions in preoperative health assessment is not yet standard of care. Major depressive disorder (MDD) is the most prevalent mental health disorder and has been shown to affect physiological processes that are critical in recovery after cardiac surgery. Methods: We queried the national inpatient sample from 2000 to 2017 for patients ≥18 years undergoing CABG with and without MDD. Patients who left against medical advice were excluded. Patients with a diagnosis of MDD were compared against those without. Our primary outcomes were in-hospital mortality, favorable discharge (home or home with services), and length of stay. Multivariable models were used for the various outcomes and each model adjusted for confounding variables. Results: A total of 2,988,997 met clinical criteria for inclusion including 108,782 with an MDD diagnosis. Most patients were male (n = 2,135,804, 71.46%), White (n = 2,417,216, 80.87%), and the average age was 66.3 years (standard deviation = 10.8 years). After adjustment, patients with a diagnosis of MDD were found to have lower odds of in-hospital mortality (odds ratio [OR] [95% confidence interval {CI}] 0.64 [0.56–0.73], P < 0.001) and had decreased odds of home discharge (OR = 0.66 [0.63–0.69], P < 0.001) after CABG. Overall, length of stay was similar between the groups, with MDD patients having a slightly longer length of stay (β-coefficient = 1.03 [1.03–1.04], P < 0.001). Patients with a diagnosis of MDD were also found to have lower odds of acute kidney injury (OR = 0.70 [0.61–0.81], P < 0.001), cardiogenic shock (OR = 0.75 [0.68–0.83], P < 0.001), infection (OR = 0.78 [0.69–0.89], P < 0.001), transient ischemic attack/stroke (OR = 0.75 [0.63–0.89], P = 0.001), acute liver injury (OR = 0.45 [0.34–0.61], P < 0.001), and acute limb ischemia (OR = 0.57 [0.40–0.82], P = 0.003). Conclusions: Patients with a diagnosis of MDD have decreased odds of postoperative morbidity and mortality after CABG in addition to having lower odds of home discharge. The present study suggests a need for prospective investigations on the impact of MDD diagnosis and outcomes after CABG to further understand this relationship.

Hepatic and Renal Outcomes in Systemic Lupus Erythematosus Patients following Coronary Artery Bypass Grafting: A Study from the National Inpatient Sample

“…Existing data suggest that SLE patients with MI and both ischemic and hemorrhagic stroke are at a higher risk of inhospital mortality [26]. In percutaneous coronary interventions, patients with SLE have similar initial intervention success but signifcantly poorer one-year outcomes and are at higher risk of MI at one-year postintervention [32]. Additionally, it has been reported that SLE patients undergoing noncardiac surgery are at increased risk for perioperative and postoperative major adverse cardiac events, including MI and death, with these results disproportionately afecting patients under the age of ffty [33].…”