A. Denegri1, L. Raeber2, S. Windecker2, B. Gencer3, F. Mach3, N. Rodondi2, D. Heg2, D. Nanchen4, C. Matter5, T. F. Luescher5 (1Mantova IT; 2Bern ; 3Geneva ; 4Lausanne ; 5Zurich)
Background: Although antidepressant therapy has been related to increased cardiovascular risk, depression and its adverse effects on prognosis is a well-recognized entity among acute coronary syndrome (ACS) patients. The aim of the study was to evaluate prevalence and outcome of antidepressant treatment in a real-world cohort of ACS patients.
Methods: We sought to assess the prevalence of established antidepressant therapy (ADT) and its impact among 2,168 all-comers patients admitted to four Swiss University Hospital for acute coronary syndrome (ACS) and enrolled in the prospective multicenter SPUM registry (NCT 01000701). The primary endpoint was all-cause mortality. The association between ADT and mortality was tested by adjusted multivariable conditional logistic regression.
Results: Out of 2,168 ACS patients, 141 patients (6.5%) had ADT. Compared with the general ACS population, ADT patients were more likely to be unemployed (p=0.001) male (p=0.002), diabetic (p=0.010) already treated with cardiovascular preventive therapy with statins or beta-blockers (p<0.001). Patients with ADT presented a 2-fold risk of all-cause mortality (OR 2.2, 95%CI 1.20-4.00, p=0.009) with a 3-fold risk of non-cardiovascular (CV) death (OR 3.24, 95%CI 1.10-9.70, p=0.026) and a 77% not significant higher risk of CV death (OR 1.77, 95%CI 0.83-3.80, p=0.130). This enhanced risk persisted after adjustment for confounding significant baseline characteristics, with a 47% (Adjusted HR 1.47, 95%CI 1.05-1.70, p=0.032, Figure 1).
Conclusions: Among a real-world cohort of ACS-patients, ADT is associated with a significant increased rate of all-cause mortality and non-CV death. These observations should lead clinicians to furtherly individualize ADT, employing newer and safer ADT, generally associated with a lower CV risk.