SSRI use in ACS patients may prevent recurrent MI, death
Depressive patients who took escitalopram, a type of selective serotonin reuptake inhibitor (SSRI), after acute coronary syndrome (ACS)-related events had lower reoccurrences of major adverse cardiac events after eight years of follow-up, Korean researchers reported in the Journal of the American Heart Association.
The researchers—led by first author Jae-Min Kim, MD, of the Chonnam National University Medical School in Gwangju, South Korea—said research on the connection between anti-depressant treatment with long-term cardiac outcomes following ACS has been inconclusive. Previous research has also been limited due to short follow-up periods, heterogeneous antidepressant regimes and limited evaluation of cardiac outcomes.
“Depression is frequently comorbid with ACS; and associated with poor outcomes including increased mortality and nonfatal events,” Kim and colleagues wrote. “A clinically important question is whether antidepressant treatment mitigates these adverse effects. In randomized clinical trials of antidepressants in ACS, mostly evaluating selective serotonin reuptake inhibitors, improvement in depressive symptoms has been demonstrated repeatedly. However, effects on cardiac outcomes have not generally been found within the treatment period.”
Kim and colleagues sought to investigate whether the effect of escitalopram versus placebo for treating depression in patients with recent ACS would result in benefits in long-term major adverse cardiac events (MACE).
The trial was conducted among 300 patients with recent ACS and a depression diagnosis. The patients were randomly assigned to receive either escitalopram in dosages of five, 10, 15 or 20 mg/d or a matched placebo for 24 weeks. The researchers followed up with patients for fie to 11 years until death or at the end of the study period in June 2017.
MACE occurred in 41 percent of patients who received escitalopram and 54 percent of patients who received placebo. The researchers also found, in all outcomes, escitalopram users had lower rates
- 21 percent of escitalopram users and 25 percent of placebo users had all-cause mortality.
- 11 percent of escitalopram users and 13 percent of placebo users had cardiac death.
- 9 percent of escitalopram users and 15 percent of placebo users had MI.
- 13 percent of escitalopram users and 20 percent of placebo users underwent percutaneous coronary intervention.
The researchers noted some differences that should be considered in the interpretation of results between their study and previous studies, specifically MIND-IT and SADHART. The treatment effects on depression were different, which may account for the absence of an effect on MACE outcomes, the levels of depressive symptoms were less severe and the anti-depressant dosages were lower in their study.
Kim et al. wrote further research is needed to assess the generalizability of their findings.
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.