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Depression's Association with Major Adverse Cardiac Events in Patients with Low-Risk Chest Pain

Amer Akkad1, Kerry Drabish2, Stephanie Thompson2

  • 1Department of Emergency Medicine, Charleston Area Medical Center, Charleston, West Virginia.

The Journal of Emergency Medicine
|August 5, 2026
PubMed

Insights

Depression significantly increases the risk of major adverse cardiac events (MACE) and emergency department (ED) revisits in low-risk chest pain patients. These findings highlight the importance of screening for depression in cardiac care.

Area of Science:

  • Cardiology
  • Psychiatry
  • Public Health

Background:

  • Depression is a known risk factor for cardiovascular disease (CVD) development and poor prognosis.
  • Research on depression's impact on CVD has overlooked low-risk patients presenting with chest pain.
  • Chest pain can indicate somatic depression or acute coronary syndrome.

Purpose of the Study:

  • To determine if documented depression is associated with short-term major adverse cardiac events (MACE) in low-risk patients.
  • To assess the association between depression and emergency department (ED) revisit rates in this population.

Main Methods:

  • Retrospective review of 4993 adult patients presenting to the ED with chest pain over 5 years.
  • Inclusion criteria: low-risk patients identified by HEART scores < 4.
  • Analysis of short-term (30 and 90 days) MACE and ED revisit rates based on depression status.

Main Results:

  • Patients with depression had significantly higher rates of 30-day (0.8% vs. 0.2%) and 90-day MACE (2.1% vs. 0.8%).
  • Depression (OR 5.000) and age predicted 90-day MACE in multivariate analysis.
  • ED revisit rates were substantially higher for patients with depression at 30 days (7.8% vs. 3.3%) and 90 days (38.8% vs. 19.4%).

Conclusions:

  • Low-risk patients with chest pain and depression exhibit elevated short-term MACE rates.
  • Depression is linked to increased emergency department utilization in this cohort.
  • These findings underscore the need to consider depression screening in cardiac risk assessment.
Abstract

Keywords:
HEART scorechest paindepressionemergency departmentmajor adverse cardiac eventsstroke

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