Efficacy and safety of selective serotonin reuptake inhibitors on cardiovascular outcomes of patients with post-acute coronary syndrome depression: a systematic review and meta-analysis

Background and Objectives Depression affects approximately 20% of patients hospitalized for acute coronary syndrome (ACS), and is associated with a two- to four-fold increased risk of cardiovascular events, and poorer quality of life. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression in cardiovascular patients due to their established benefit for depression. Given the significant prevalence of depression in this population and its impact on outcomes, this meta-analysis aimed to evaluate the role of SSRIs in reducing all-cause mortality, rehospitalization, and recurrence of myocardial infarction in post-ACS patients with depression. Methodology Databases were systematically searched for RCTs involving the use of SSRIs in patients with post-ACS depression. Studies were assessed for their design and quality using the GRADEpro approach, and a meta-analysis was conducted on the studies for the mentioned outcomes. Results Eight RCTs were included in the study. The study revealed that in patients with ACS and eventual clinical depression, SSRIs significantly reduced all-cause mortality—HR 0.53 (0.39–0.73, 95% CI)—and significantly reduced rehospitalization—HR 0.31 (0.12–0.75, 95% CI). However, there was no significant difference in recurrence of acute myocardial infarction—HR 0.85 (0.66–1.10, 95% CI). The most commonly cited adverse drug event was dizziness. Conclusion SSRIs showed significant benefit in reducing all-cause mortality and rehospitalization in patients with post-ACS depression, but did not show significant benefit in preventing recurrence of acute myocardial infarction. SSRIs can then be given to patients with post-ACS depression to improve overall clinical outcomes. More RCTs are needed especially in terms of rehospitalization.