Less revascularization and increased in-hospital mortality in patients with schizophrenia spectrum disorder after myocardial infarction

Background Revascularization improves the outcome of myocardial infarction. Patients with severe mental illness frequently receive suboptimal treatment for cardiovascular diseases. Purpose We investigated the association of schizophrenia spectrum disorder (SCZ) with revascularization and in-hospital mortality after myocardial infarction. Methods Consecutive patients with myocardial infarction in Finland during 2009-2018 were retrospectively studied using a combination of national registries (n=71,225). Schizophrenia spectrum disorder was present in 0.8% (n=594; mean age 66 years, 42% women, 74% with schizophrenia). Differences between study groups were adjusted for with multivariable regression. Results Revascularization was performed to 50.3% of patients with SCZ and to 60.5% of patients without SCZ (adjusted OR 0.55; CI 0.46-0.66; p<0.0001). Of patients with SCZ, 43.9% were treated with percutaneous coronary intervention vs. 54.6% of patients without SCZ (adj.OR 0.57; CI 0.46-0.69; p<0.0001). There was no difference for CABG between study groups (6.7% for both; p=0.886). Older age, female sex, schizophrenia, psychiatric ward treatment within a year before myocardial infarction, non-ST-elevation myocardial infarction, and treatment in non-university hospital were associated with lower odds for revascularization in patients with SCZ. Usage of revascularization improved during the study period. In-hospital mortality was 14.8% in patients with and 10.8% in patients without SCZ (adj.OR 2.25; CI 1.73-2.91; p<0.0001). Conclusions Patients with SCZ receive percutaneous revascularization less frequently and have higher in-hospital mortality after myocardial infarction. Patients with recent psychiatric ward treatment are especially poorly revascularized. These results underline the need for improving invasive treatment strategies in myocardial infarction patients with SCZ.