OBJECTIVE: To determine which particular depressive symptom scales, derived from 
three scales, predicted poorer prognosis in persons with acute coronary syndrome 
(ACS).
METHODS: Hospitalized ACS patients (n=408) completed questionnaires (depression, 
vital exhaustion). Mokken scaling derived unidimensional scales. Major cardiac 
events (cardiac mortality, ACS, unplanned revascularization) were assessed at 
median 67 weeks post event.
RESULTS: Only depressive symptoms of fatigue-sadness predicted prognosis in 
univariate (hazard ratio [HR]=1.8, 95% CI 1.1-3.0, P=.025) and multivariate 
analysis (HR=1.8, 95% CI 1.1-2.9, P=.025). Symptoms of anhedonia (HR=1.6, 95% CI 
0.9-2.8, P=.102) and depressive cognitions (HR=1.3, 95% CI 0.7-2.2, P=.402) did 
not.
CONCLUSION: Symptoms of fatigue-sadness, but not other symptoms, were associated 
with increased risk of major cardiac events. Depression should be considered as 
a multidimensional, rather than a unidimensional, entity when designing 
interventions.