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

Background: Depression is common in patients with cardiovascular disease. The importance of preoperative depression for long-termsurvival 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 allcause 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 reviewandmeta-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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.