Key result
Use of selective serotonin reuptake inhibitors in depressed patients post-myocardial infarction was associated with a lower risk of death or recurrent MI (HR 0.57; 95% CI 0.38-0.84).
Why the study?
Does the use of antidepressant medication reduce morbidity and mortality in depressed patients after myocardial infarction?
Observational (n=1,834)
Yes
Does the use of antidepressant medication reduce morbidity and mortality in depressed patients after myocardial infarction?
Hazard Ratio: 0.57 (95% CI 0.38–0.84)
The use of selective serotonin reuptake inhibitors in depressed patients after an acute MI is associated with reduced subsequent cardiovascular morbidity and mortality.
Antidepressant use was associated with lower post-MI death or recurrent events; leaves open whether SSRIs improve outcomes and should not yet change practice.
BACKGROUND: Depression after myocardial infarction (MI) is associated with higher morbidity and mortality. Although antidepressants are effective in reducing depression, their use in patients with cardiovascular disease remains controversial. OBJECTIVE: To undertake a secondary analysis to determine the effects of using antidepressants on morbidity and mortality in post-MI patients who participated in the Enhancing Recovery in Coronary Heart Disease study. DESIGN: Observational secondary analysis. SETTING: Eight academic sites. PATIENTS: The Enhancing Recovery in Coronary Heart Disease clinical trial randomized 2481 depressed and/or socially isolated patients from October 1, 1996, to October 31, 1999. Depression was diagnosed using a structured clinical interview. This analysis was conducted on the 1834 patients enrolled with depression (849 women and 985 men). INTERVENTION: Use of antidepressant medication. MAIN OUTCOME MEASURES: Event-free survival was defined as the absence of death or recurrent MI. All-cause mortality was also examined. To relate exposure to antidepressants to subsequent morbidity and mortality, the data were analyzed using a time-dependent covariate model. RESULTS: During a mean follow-up of 29 months, 457 fatal and nonfatal cardiovascular events occurred. The risk of death or recurrent MI was significantly lower in patients taking selective serotonin reuptake inhibitors (adjusted hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.38-0.84), as were the risk of all-cause mortality (adjusted HR, 0.59; 95% CI, 0.37-0.96) and recurrent MI (adjusted HR, 0.53; 95% CI, 0.32-0.90), compared with patients who did not use selective serotonin reuptake inhibitors. For patients taking non-selective serotonin reuptake inhibitor antidepressants, the comparable HRs (95% CIs) were 0.72 (0.44-1.18), 0.64 (0.34-1.22), and 0.73 (0.38-1.38) for risk of death or recurrent MI, all-cause mortality, or recurrent MI, respectively, compared with nonusers. CONCLUSIONS: Use of selective serotonin reuptake inhibitors in depressed patients who experience an acute MI might reduce subsequent cardiovascular morbidity and mortality. A controlled trial is needed to examine this important issue.
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C. Barr Taylor (2005) conducted an observational in Depression after myocardial infarction (n=1,834). Selective serotonin reuptake inhibitors vs. Nonusers was evaluated on Death or recurrent MI (HR 0.57, 95% CI 0.38-0.84). Use of selective serotonin reuptake inhibitors in depressed patients post-myocardial infarction was associated with a lower risk of death or recurrent MI (HR 0.57; 95% CI 0.38-0.84).
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