Key result
SSRI use after acute coronary syndrome was associated with an increased risk of MACE or mortality compared to no antidepressant use (adjusted HR 1.83, 95% CI 1.09-3.06, P=0.02).
Why the study?
Does SSRI or non-SSRI second-generation antidepressant use affect the long-term occurrence of major adverse cardiovascular events and mortality in patients after an acute coronary syndrome?
Cohort (n=432)
Does SSRI or non-SSRI second-generation antidepressant use affect the long-term occurrence of major adverse cardiovascular events and mortality in patients after an acute coronary syndrome?
Answers are grounded in this paper and cite their sources.
In an observational cohort of post-ACS patients followed for a median of 40 months, SSRI use—particularly when initiated during the index hospitalization—was independently associated with a higher risk of MACE or mortality compared with no antidepressant use.
Depression is highly prevalent among patients with coronary heart disease.1 Selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line antidepressant treatments for this population.2,3 Whereas there is a long-standing notion that SSRIs may improve cardiac disease prognosis by inhibiting platelet aggregation, SSRI use may also worsen prognosis by increasing bleeding4 or increasing the risk for arrhythmia.5 Only a few small randomized clinical trials with a total of 801 patients have assessed the efficacy of SSRIs in patients with a cardiac condition.6,7 Although no evidence for harm was detected in 2 meta-analyses, the follow-up periods for adverse cardiac events in these trials did not extend beyond 6 months, and patient samples were highly selected (ie, only patients not already receiving antidepressant therapy in usual care were included, and patients with comorbid conditions were excluded). In a cohort of patients with acute coronary syndrome (ACS), we evaluated the association of SSRI and non-SSRI second-generation antidepressant use with the occurrence of cardiac events and mortality during a median follow-up period of 40 months.
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Rieckmann et al. (2013) conducted a cohort in Acute coronary syndrome (ACS) (n=432). Selective serotonin reuptake inhibitor (SSRI) use vs. No antidepressant use (and non-SSRI second-generation antidepressant use) was evaluated on Composite of major adverse cardiovascular events (MACE: hospitalization for nonfatal myocardial infarction, unstable angina, or urgent/emergency percutaneous or surgical coronary revascularization) or all-cause mortality (HR 1.83, 95% CI 1.09-3.06, p=0.02). SSRI use after acute coronary syndrome was associated with an increased risk of MACE or mortality compared to no antidepressant use (adjusted HR 1.83, 95% CI 1.09-3.06, P=0.02).
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