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Antidepressant treatment in patients following acute coronary syndromes: a systematic review and Bayesian

Romy Sweda1,2, George C M Siontis1, Adriani Nikolakopoulou3

  • 1Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, CH-3010, Switzerland.

ESC Heart Failure
|September 16, 2020
PubMed

Insights

Antidepressant therapy after acute coronary syndrome (ACS) does not impact mortality but reduces hospitalizations. For ACS patients with depression, antidepressants lower the risk of recurrent myocardial infarction.

Area of Science:

  • Cardiology
  • Psychiatry
  • Pharmacology

Background:

  • Acute coronary syndrome (ACS) is a critical cardiovascular event.
  • Depression is a common comorbidity in ACS patients, impacting outcomes.
  • The role of antidepressant therapy in managing ACS patients is under investigation.

Purpose of the Study:

  • To evaluate the impact of antidepressant therapy on mortality and cardiovascular outcomes in patients post-ACS.
  • To assess the efficacy of antidepressants in reducing all-cause mortality, repeat hospitalizations, and recurrent myocardial infarctions (MIs).

Main Methods:

  • A systematic search of PubMed, Embase, and Cochrane Central Register was conducted.
  • Bayesian random-effects meta-analysis of 10 randomized controlled trials (1935 patients) was performed.
  • Primary outcome: all-cause mortality. Secondary outcomes: repeat hospitalizations and recurrent MIs.

Main Results:

  • Antidepressant therapy showed no significant effect on all-cause mortality (OR 0.97, 95% CrI 0.66-1.42) or recurrent MI (OR 0.64, 95% CrI 0.40-1.02).
  • A significant reduction in repeat hospitalizations was observed with antidepressant use (OR 0.62, 95% CrI 0.40-0.94).
  • In ACS patients with depression, antidepressants significantly reduced the odds of recurrent MI (OR 0.45, 95% CrI 0.25-0.81).

Conclusions:

  • Antidepressants do not influence mortality rates in patients following ACS.
  • Antidepressant therapy is associated with a decrease in repeat hospitalizations post-ACS.
  • For ACS patients experiencing depression, antidepressant treatment offers a reduced risk of recurrent myocardial infarction.
Abstract

Keywords:
Acute coronary syndromeAntidepressantsDepressionMental healthMeta-analysisMyocardial infarction

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