Cardiovascular Outcomes After Percutaneous Coronary Intervention in Patients With Serious Mental Illness

Objective Serious mental illness is associated with excess cardiovascular risk, but outcomes after contemporary percutaneous coronary intervention (PCI) remain unclear. The purpose of this paper is to examine PCI outcomes among those with serious mental illness. Methods Using TriNetX database, adults undergoing PCI with schizophrenia, bipolar disorder, or major depressive disorder were compared with propensity-matched controls without psychiatric diagnoses in this retrospective cohort study. Outcomes included statin and P2Y12 inhibitor prescription, cardiac rehabilitation referral, major adverse cardiovascular events, all-cause mortality, and repeat revascularization at 30 days and 1 year. Hazard ratios are reported as controls relative to psychiatric cohorts. Results After matching, 6766 patients with bipolar disorder, 52 375 with depression, and 5685 with schizophrenia were analyzed. Use of statins was higher, and antiplatelet therapy was similar in psychiatric cohorts. Compared with controls, bipolar disorder (n = 6766) was associated with higher MACE at 30 days (HR 1.12, P < 0.001) and 1 year (HR 1.10, P < 0.001). Depression (n = 52 375) was associated with higher MACE at 30 days (HR 1.14, P < 0.001) and 1 year (HR 1.13, P < 0.001). Schizophrenia (n = 5685) was associated with higher MACE at 30 days (HR 1.15, P < 0.001) and 1 year (HR 1.19, P < 0.001). Repeat revascularization was higher in bipolar disorder and depression but not different in schizophrenia. All-cause mortality was lower in bipolar disorder and depression but was comparable in schizophrenia relative to matched controls without psychiatric diagnoses. Conclusions Serious mental illness is associated with worse cardiovascular outcomes after PCI despite similar or higher rates of documented post-PCI prescription and cardiac rehabilitation referral.