Gwangju, South Korea—Does treating depression with pharmaceuticals shortly after acute coronary syndrome improve long-term cardiac outcomes?

A study published recently in JAMA suggests it does. South Korean researchers conducted a randomized clinical trial involving 300 patients with recent acute coronary syndrome and depression. They report that 24-week treatment with escitalopram or placebo resulted in a statistically significant occurrence of major adverse cardiac outcomes of 40.9% versus 53.6% after a median follow-up of 8.1 years.

Background information in the article notes that depression has been linked with poorer medical outcomes in acute coronary syndrome (ACS), but few studies have looked at the effects of antidepressant treatment on long-term prognosis.

“Depression is frequently comorbid with acute coronary syndrome (ACS; including myocardial infarction [MI] and unstable angina) and associated with poor outcomes including increased mortality and nonfatal events,” the researchers write. “A clinically important question is whether antidepressant treatment mitigates these adverse effects.”

To help answer that, the study team investigated the effect on long-term major adverse cardiac events (MACE) when escitalopram was used to treat depression in patients with recent ACS.

Patients were enrolled in the study from May 2007 to March 2013, with follow-up completed in June 2017, at Chonnam National University Hospital in Gwangju, South Korea. Study participants were randomly assigned to receive either escitalopram in flexible dosages of 5, 10, 15, or 20 mg/d or matched placebo for 24 weeks.

MACE, a composite of all-cause mortality, myocardial infarction (MI), and percutaneous coronary intervention (PCI), was defined as the primary outcome, with four secondary outcomes including all-cause mortality, cardiac death, MI, and PCI.

Participants had a mean age of 60 years, and the majority were men.

Results indicate a hazard ratio (HR) of 0.69 for MACE in patients receiving escitalopram versus those receiving placebo.

Comparing individual MACE outcomes between the escitalopram and placebo groups, respectively, incidences were:
• For all-cause mortality, 20.8% versus 24.5% (HR, 0.82; 95% CI, 0.51-1.33; P = .43),
• For cardiac death, 10.7% versus 13.2% (HR, 0.79; 95% CI, 0.41-1.52; P = .48);
• For MI, 8.7% versus 15.2% (HR, 0.54; 95% CI, 0.27-0.96; P = .04), and
• For PCI, 12.8% versus 19.9% (HR, 0.58; 95% CI, 0.33-1.04; P = .07).

“Among patients with depression following recent acute coronary syndrome, 24-week treatment with escitalopram compared with placebo resulted in a lower risk of major adverse cardiac events after a median of 8.1 years,” study authors conclude. “Further research is needed to assess the generalizability of these findings.”

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