Association between preoperative depression and long-term survival following coronary artery bypass surgery - A systematic review and meta-analysis

Int J Cardiol. 2016 Nov 1;222:462-466. doi: 10.1016/j.ijcard.2016.07.216. Epub 2016 Jul 29.


Background: Depression is common in patients with cardiovascular disease. The importance of preoperative depression for long-term survival following coronary artery bypass grafting (CABG) is not well known. The aim was to provide a summary estimate of the association between preoperative depression and long-term survival in adults who underwent CABG.

Methods: We did a systematic search of MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science, and PubMed from inception to November, 2015, including cohort studies with at least one month of follow-up that reported hazard ratios (HR) and 95% confidence intervals (CI) for long-term all-cause mortality following CABG in patients with preoperative depression compared to non-depressed patients. Two reviewers independently extracted data on populations, exposure, outcome, risk of bias, and quality of evidence. We calculated HR and 95% CIs for all-cause mortality using random-effects meta-analyses and performed subgroup and sensitivity analyses.

Results: Seven studies were included with a combined study population of 89,490 patients (4002 depressed/85,488 non-depressed). All studies observed a positive association between preoperative depression and all-cause mortality, and in 4 studies the association was statistically significant. Patients with depression had a pooled hazard ratio of 1.46 (95% CI: 1.23-1.73, p<0.0001) for all-cause mortality with moderate heterogeneity (I(2)=50.1%, p=0.061).

Conclusions: This systematic review and meta-analysis indicates that patients with preoperative depression are at increased risk for long-term, all-cause mortality following CABG compared with those without depression. Systematic screening for depression prior to cardiac surgery could identify those at higher risk.

Keywords: Coronary artery bypass grafting; Depression; Meta-analysis; Survival; Systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Cohort Studies
  • Coronary Artery Bypass / mortality*
  • Coronary Artery Bypass / trends
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / mortality*
  • Coronary Artery Disease / surgery
  • Depressive Disorder / diagnosis
  • Depressive Disorder / mortality*
  • Humans
  • Preoperative Care / methods
  • Preoperative Care / mortality*
  • Preoperative Care / trends
  • Survival Rate / trends
  • Time Factors