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Effect of Selective Serotonin Reuptake Inhibitors on Cardiovascular Outcomes After Percutaneous Coronary
Carlo J Iasella1, Madeline S Kreider1, Lin Huang2
1Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, 335 Sutherland Drive, Room 209 Salk Pavilion, Pittsburgh, PA, 15261, USA.
Insights
Selective serotonin reuptake inhibitors (SSRIs) showed lower major adverse cardiac events (MACE) risk compared to mirtazapine in patients with coronary artery disease (CAD) on dual antiplatelet therapy (DAPT). Bleeding risk was not significantly different between groups.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Depression and coronary artery disease (CAD) frequently co-occur, posing significant health risks.
- Antidepressant efficacy is similar in CAD patients, but cardiovascular safety profiles differ.
- Selective serotonin reuptake inhibitors (SSRIs) have antiplatelet effects, unlike mirtazapine, raising questions about their impact post-percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate the effect of SSRI treatment on major adverse cardiac events (MACE) and bleeding in patients undergoing clopidogrel-based dual antiplatelet therapy (DAPT) after PCI.
- To compare outcomes between SSRI users, mirtazapine users, and those on neither antidepressant agent.
Main Methods:
- Retrospective study analyzing MACE and bleeding events within one year of PCI.
- Comparison of three groups: SSRI, mirtazapine, and neither antidepressant.
- Time-to-event analysis using Kaplan-Meier estimators and adjusted Cox proportional hazards models.
Main Results:
- SSRI use was associated with lower MACE risk compared to mirtazapine (HR 0.61).
- SSRI use was associated with higher MACE risk compared to no antidepressant use (HR 1.21).
- No significant difference in bleeding risk was observed between SSRI and neither antidepressant groups.
Conclusions:
- SSRI treatment demonstrated a reduction in MACE rates relative to mirtazapine in patients on DAPT post-PCI.
- Antidepressant choice did not significantly impact bleeding risk.
- SSRIs may offer cardioprotective benefits over mirtazapine in this patient population.
Background:
Depression and coronary artery disease (CAD) are leading causes of death and disability and commonly co-occur. Different antidepressant classes have similar efficacy for depressed patients with CAD, but cardiovascular implications are unclear. Selective serotonin reuptake inhibitors (SSRIs) and mirtazapine are first-line options for depressed patients with CAD. SSRIs, but not mirtazapine, have known antiplatelet effects. Whether this affects risk of bleeding and major adverse cardiac events (MACE) in patients requiring dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is unknown.
Objective:
The aim of this analysis is to examine the impact of SSRI treatment on the co-primary endpoints of composite MACE (death, myocardial infarction, or stroke) and composite bleeding events in patients treated with clopidogrel-based DAPT after PCI.
Methods:
We conducted a retrospective study with co-primary endpoints of bleeding and MACE within 1 year of PCI. Three groups were compared: SSRI patients, mirtazapine patients, and patients on neither agent. Mirtazapine acted as a comparator to control for depression, for which diagnosis coding was inadequate. Time-to-event analyses were performed with Kaplan-Meier estimators and adjusted analyses utilized Cox proportional hazards. There were 6874 (820 SSRI, 55 mirtazapine, 5999 neither) patients included.
Results:
SSRI patients had lower MACE risk than mirtazapine patients (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.38-0.97, p = 0.036) but higher MACE risk than patients on neither agent (HR 1.21, 95% CI 1.02-1.43, p = 0.030) in adjusted analyses. No significant differences were associated with bleeding risk (SSRI vs. neither adjusted HR 1.07, 95% CI 0.93-1.24, p = 0.36).
Conclusion:
SSRI use was associated with a significant decrease in MACE rates compared with patients receiving mirtazapine. Bleeding risk was not affected by either antidepressant treatment. SSRIs may have cardioprotective benefits compared with mirtazapine.
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