Association of Baseline SSRI use with post-STEMI outcomes in patients with depression

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is associated with high morbidity and mortality, and comorbid major depressive disorder (MDD) is linked to worse cardiovascular outcomes. The association between selective serotonin reuptake inhibitors (SSRIs), first-line therapy for MDD, and clinical outcomes in patients with STEMI remains incompletely defined. METHODS: We performed a retrospective cohort study using the TriNetX Research Network. Adult patients with STEMI and MDD were stratified by SSRI exposure at or prior to the index STEMI event. Propensity score matching was used to balance demographic characteristics, cardiovascular comorbidities, psychiatric conditions, and cardiac medications. Primary outcome was all-cause mortality at 1 month, 1 year, and 3 years. RESULTS: Among 22,427 patients with STEMI and MDD, 18.9% had documented SSRI use at their baseline. After propensity score matching, baseline SSRI use was not associated with recurrent myocardial infarction or ischemic stroke at any time point. Baseline SSRI use was associated with lower all-cause mortality from 30 days to 1 year and 3 years post-STEMI. Baseline SSRI therapy was additionally associated with higher rates of of major bleeding at 3 years post-STEMI and hospital readmission at 1 year post-STEMI. CONCLUSIONS: In this large, propensity-matched cohort of patients with STEMI and MDD, baseline SSRI use was associated with a lower all-cause mortality without higher rates of recurrent myocardial infarction or stroke. These findings suggest an association between SSRI use and favorable mortality outcomes in this population, although residual confounding cannot be ruled out.