Gender-related differences in comprehensive assessment of prognosis of myocardial infarction using the anxiety and depression scales

The aim of the study was to elucidate gender-related differences in the effects of anxiety-depression disorders on the prognosis of myocardial infarction (MI) and to develop a complex of clinical-instrumental and psychophysiologic indicators predicting 1-year prognosis in MI depending on patient gender. Materials and Methods: the study included a total of 346 patients with Q-wave MI who were admitted to hospital during the first 24 hours after MI beginning and discharged for out-patient treatment. At day 5-7 of MI, the following studies were performed: clinical status evaluation, 24-h ECG monitoring with assessment of heart rate variability (HRV), echocardiography, and psychological testing for depression by Zung scale and for personal and reactive anxiety by Spielberg-Hanin scale. One year after MI beginning, cases of fatal outcomes, repeated MI, unstable angina, and repeated hospitalizations were studied. Results: In men with MI, unlike that in women, evaluation of the complex of unfavorable psychophysiological and clinical parameters resulted in increase in the prognosis efficacy. Association of high levels of personal anxiety and depression during an in-hospital period predicted unfavorable 1-year prognosis with 90% probability whereas the absence of these disorders predicted favorable course of disease. The use of psychological assessment scales together with assessment of left ventricular (LV) ejection fraction (EF) or HRV (SDNN) increased prediction efficacy to 100%. Conclusion: Significance of the prognostic factor complex in MI differs depending on patient gender. The presence of high levels of anxiety and depression during in-hospital period in men suggested unfavorable 1-year prognosis especially in the presence of a decrease in LV EF and HRV. However, development of other, more effective prediction models is required for women with MI.