Psychiatric Comorbidity and Disparities in the Invasive Management of Acute Myocardial Infarction: A National Analysis, 2016–2023

Structured Abstract Background and Objective Mental health disorders (MHD) are common in acute myocardial infarction (AMI) and have been associated with less intensive cardiac care. We examined trends in five MHD and their adjusted associations with in-hospital mortality, mechanical circulatory support (MCS), and coronary revascularization. Methods We analyzed the National Inpatient Sample, 2016–2023, including adult hospitalizations with a principal diagnosis of AMI (ICD-10-CM I21.x/I22.x, excluding type 2 MI); five MHD were identified from secondary diagnoses. Survey-weighted logistic regression produced adjusted odds ratios (aORs), adjusting for demographics, hospital characteristics, MI type, and 19 comorbidities, with all five MHD entered simultaneously. Sensitivity analyses were restricted to hospitalizations without prior MI, PCI, or CABG. Results Among 970,969 AMI hospitalizations, prevalence rose for every MHD except schizophrenia/psychotic disorders, most steeply for PTSD. Schizophrenia/psychotic disorders had the lowest adjusted odds of revascularization (aOR, 0.56; 95% CI, 0.53–0.60) and invasive management (0.52; 0.49–0.55), followed by bipolar disorder (revascularization 0.81; 0.78–0.85); MCS associations were attenuated after adjustment. Restricted to those without prior coronary disease, the schizophrenia deficit was larger (0.54; 0.50–0.57) than among those with prior coronary disease (0.67; 0.60–0.74; interaction P < .001). Depression, anxiety, bipolar disorder, and PTSD were associated with lower adjusted in-hospital mortality (all P < .001); schizophrenia/psychotic disorders showed no significant difference (1.11; 0.98–1.26; P = .09). Conclusions Schizophrenia and other psychotic disorders were consistently associated with markedly lower odds of invasive evaluation and coronary revascularization after AMI, with the largest deficit at first presentation. These findings highlight a potentially modifiable gap in cardiovascular care.