Comparison of Recent Trends in Patients With and Without Major Depression and Acute ST-Elevation Myocardial
Joshua Schulman-Marcus1, Tara Shah2, Rajesh V Swaminathan2
1Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York.
Insights
The incidence of ST-elevation myocardial infarction (STEMI) is not decreasing in patients with depression, unlike the general population. These patients also receive less percutaneous coronary intervention (PCI) treatment.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Depression is linked to worse outcomes after acute coronary syndrome, including ST-elevation myocardial infarction (STEMI).
- Current trends in STEMI incidence and treatment for patients with co-morbid depression are not well understood.
Purpose of the Study:
- To investigate trends in STEMI incidence and in-hospital treatment (percutaneous coronary intervention - PCI) among patients with and without depression.
- To analyze in-hospital mortality trends in STEMI patients with co-morbid depression.
Main Methods:
- A serial, cross-sectional analysis of 3,057,998 STEMI patients from the National Inpatient Sample (2003-2012).
- Multivariate logistic regression was used to assess differences and trends in treatment and mortality.
- Patients were stratified based on the presence or absence of depression.
Main Results:
- STEMI incidence decreased by 52% in patients without depression but remained stable in those with depression.
- Patients with depression were less likely to receive PCI (adjusted odds ratio 0.90).
- While crude mortality was lower in patients with depression, this finding requires further investigation in the context of treatment disparities.
Conclusions:
- Unlike the general population, STEMI incidence is not declining in patients with co-morbid depression.
- Patients with STEMI and depression receive PCI less frequently, indicating a potential disparity in care.
- These findings highlight the need for increased attention to the cardiovascular health of patients with depression.
Abstract:
Depression has been associated with adverse outcomes after acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). However, trends over time in the incidence and inhospital treatment of STEMI for patients with co-morbid depression in the current era are unknown. We conducted a serial, cross-sectional analysis of patients with STEMI (weighted n = 3,057,998) in the National Inpatient Sample from 2003 to 2012. We examined trends in STEMI incidence and percutaneous coronary intervention (PCI) for patients with and without depression. We used multivariate logistic regression to assess observed differences and to explore trends in inhospital mortality. Depression was present in 153,180 (5%) of the sample. Patients with depression were more likely to be female (55% vs 37%), of white race (86% vs 78%), and had lower crude mortality (12.0% vs 14.2%; p <0.001 for all). Over time, STEMI incidence decreased 52% in patients without depression (p for trend <0.001) but remained stable in those with depression (p for trend 0.74). Although the use of PCI increased in all subgroups over the study duration (p for trend <0.001), depression was associated with lower adjusted odds of PCI (odds ratio 0.90, 95% confidence interval 0.89 to 0.92, p <0.001). In conclusion, in contrast to the wider population, the incidence of STEMI is not decreasing in patients with co-morbid depression. Patients with STEMI and co-morbid depression are less likely to receive revascularization therapy with PCI. These concerning differences warrant further attention.
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Depressive Disorders: MDD and Dysthymia
01:23Antidepressant Drugs: MAOIs and Other Agents