Key result
Higher obsessive-compulsive symptoms at baseline in patients with acute coronary syndrome were associated with a significantly increased risk of major adverse cardiac events (adjusted HR 1.60) compared to lower symptoms.
Why the study?
The role of obsessive-compulsive symptoms in patients with ACS is not well elucidated, prompting investigation into their association with long-term ACS prognosis alongside depression comorbidity and treatment.
Does the presence of obsessive-compulsive symptoms affect long-term major adverse cardiac events in patients with acute coronary syndrome, and is this modified by escitalopram treatment for comorbid depression?
Cohort (n=1,152)
No
Does the presence of obsessive-compulsive symptoms affect long-term major adverse cardiac events in patients with acute coronary syndrome, and is this modified by escitalopram treatment for comorbid depression?
Hazard Ratio: 1.6 (95% CI 1.32–1.94)
Absolute Event Rate: 46.2% vs 31.3%
p-value: p=<0.001
Obsessive-compulsive symptoms are associated with worse long-term cardiovascular outcomes in ACS patients, an effect that may be mitigated by escitalopram treatment in those with comorbid depression.
OBJECTIVE: The role of obsessive-compulsive symptoms (OCS) in patients with acute coronary syndrome (ACS) is not well elucidated. This study investigated the association between OCS and the long-term prognosis of ACS in tandem with depression comorbidity and treatment. METHODS: A cross-sectional baseline study and a nested 24-week double-blind escitalopram-placebo controlled trial were carried out between May 2007 and March 2013, and then a 5-12-year follow-up for major adverse cardiac events (MACE) was conducted. A total of 1,152 patients with ACS were stratified by baseline depression comorbidity and treatment allocation into four groups: no depression (706 patients), depression and taking escitalopram (149 patients), depression and taking a placebo (151 patients), and depression and receiving medical care as usual (CAU; 146 patients). OCS were evaluated using the Symptom Checklist-90-Revised Obsessive-Compulsive symptom domain. During the follow-up, Kaplan-Meier event rates for MACE outcomes were calculated, and hazard ratios were estimated using Cox regression models after adjusting for a range of covariates. RESULTS: A higher OCS score at baseline was associated with a worse ACS prognosis after adjusting for relevant covariates and across MACE outcomes. This association varied according to the depression comorbidity. The association was significant in patients without depression and depressive patients receiving placebos and CAU, but not in depressive patients on escitalopram. CONCLUSION: Evaluating OCS and depression is recommended during the early phase of ACS. Treatment for OCS may improve the longterm cardiac outcomes of patients with ACS.
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Lee et al. (2019) conducted a cohort in Acute Coronary Syndrome (ACS) (n=1,152). Higher obsessive-compulsive symptoms (OCS) vs. Lower obsessive-compulsive symptoms (OCS) was evaluated on Major adverse cardiac event (MACE), a composite of all-cause mortality, MI, and PCI (HR 1.60, 95% CI 1.32-1.94, p=<0.001). Higher obsessive-compulsive symptoms at baseline in patients with acute coronary syndrome were associated with a significantly increased risk of major adverse cardiac events (adjusted HR 1.60) compared to lower symptoms.
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