Combined impact of inflammation score and depression on clinical outcomes in patients after percutaneous coronary intervention: a retrospective cohort study.

backgroundSystemic inflammation and depressive symptoms are both associated with adverse cardiovascular prognosis, but their combined prognostic value after percutaneous coronary intervention (PCI) remains uncertain. This study examined the individual and joint associations of inflammatory score (IS) and clinically relevant depressive symptoms with traditional major adverse cardiovascular events (MACE).

methodsA total of 487 patients with angiographically confirmed coronary artery disease were included. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9), with PHQ-9 ≥ 10 used as the primary definition of clinically relevant depressive symptoms. IS was calculated from z-scores of C-reactive protein and white blood cell count and dichotomized using the original cohort-specific median cutoff (-0.78). The primary outcome was traditional MACE. Cox regression, restricted cubic spline, additive interaction, and exploratory discrimination analyses were performed.

resultsDuring follow-up, 134 patients (27.5%) experienced MACE. After extensive cardiovascular adjustment, PHQ-9 ≥ 10 remained independently associated with MACE (HR 1.91, 95% CI 1.08-3.39, P = 0.027), whereas high IS alone was not significant (HR 1.34, 95% CI 0.89-2.00, P = 0.159). Patients with both high IS and PHQ-9 ≥ 10 had the highest MACE risk compared with those with low IS and PHQ-9 < 10 (HR 3.50, 95% CI 1.58-7.76, P = 0.002). hs-CRP threshold analyses were less consistent, and additive interaction estimates were imprecise.

conclusionsPHQ-9 ≥ 10 was independently associated with traditional MACE. Coexistence of high IS and PHQ-9 ≥ 10 identified a high-risk subgroup, although IS and additive interaction findings require cautious interpretation.