Increased risk of mortality among antidepressant users with acute coronary syndrome: insights from the prospective SPUM-ACS study

Abstract Background Antidepressant pharmacotherapy (ADP) has been related to increased cardiovascular risk and its use among acute coronary syndrome (ACS) patients remains controversial. Purpose The aim of the study was to evaluate prevalence and outcome of antidepressant treatment in a real-world cohort of ACS patients. Methods We sought to assess the prevalence of established ADP and its impact among ACS patients admitted to four Swiss University Hospital enrolled in the prospective multicenter SPUM registry. The primary endpoint was all-cause mortality. The association between ADP and mortality was tested by adjusted multivariable conditional logistic regression. Results Out of 4’787 ACS patients, 317 patients (6.6%) had ADP. Compared with the overall population, ADP patients were more likely to be younger (65.1±12.2 vs 66.9±11.8, p=0.015), of female sex (34.7% vs 22.5%, p0.001) and smokers (40.4% vs 31.0%, p=0.001). They presented less frequently with hypertension (63.0% vs 75.5%, p0.001) and alcohol consumption (43.2% vs 55.2%, p0.001). Secondary prevention therapy with aspirin (37.9% vs 45.0%, p=0.009) or angiotensin receptor antagonists (24.1% vs 31.8%, p=0.003) was less prescribed in ADP patients and they presented with a slightly increased glomerular filtration rate (82.1±21.5 vs 79.5±21.9, p=0.05). At 1 year follow-up, ADP patients experienced an almost 2-fold risk of all-cause mortality and cardiovascular (CV) mortality. This enhanced risk persisted after adjustment for confounding significant baseline characteristics for all-cause mortality (Adjusted HR 2.1, 95%CI 1.4-3.2, p=0.001, Figure 1) and CV mortality (Adjusted HR 2.1, 95%CI 1.2-3.5, p=0.007, Figure 1). Conclusions Among a real-world cohort of ACS-patients, ADP is associated with a significant increased rate of all-cause mortality and CV mortality. These observations may in part be related to their less favorable clinical phenotype and a less optimal management of their condition. Clinicians should be aware to these findings, assure equally optimal treatment in such patients and further individualize ADP, employing newer and safer ADP.Cumulative survival