Clinical Edge

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Depression Treatment & Mortality After Acute MI

Circulation; 2017 May 2; Smolderen, Buchanan, et al

Depression in patients with acute myocardial infarction (AMI) is associated with increased long-term mortality; however, this association may be confined to patients with untreated depression, a recent study found. 759 patients aged ≥18 years with AMI between April 11, 2005, and December 31, 2008, from the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status (TRIUMPH) study met criteria for depression and were included. Researchers found:

  • 231/791 (30.4%) patients were treated for depression.
  • The 231 patients with treated depression had 1-year mortality rates that were not different from the 3,303 patients without depression.
  • Conversely, the 528 patients with untreated depression had higher 1-year mortality vs patients without depression (10.8% vs 6.1%).

Citation:

Smolderen KG, Buchanan DM, Gosch K, et al. Depression treatment and 1-year mortality after acute myocardial infarction. Circulation. 2017;135:1681-1689. doi:10.1161/CIRCULATIONAHA.116.025140.

Commentary:

It has been known for a long time that depression is common post-MI and is related to an increase in mortality and morbidity. In fact, the American Heart Association recently issued a scientific statement declaring depression as a risk factor for poor prognosis in patients post-MI and with acute coronary syndromes.1 The question for a long time has been whether treatment of depression would improve outcomes. Given the impact of depression on quality of life as well as possible outcomes, it would be unethical for a randomized study to be conducted to answer this question. The current study, using an observational trial design, now gives us an answer. Not only does depression in patients post-MI correlate with a substantial increase in mortality, but treatment of that depression brings outcomes in line with that of patients who do not suffer from depression. —Neil Skolnik, MD

  1. Lichtman JH, Froelicher ES, Blumenthal JA, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: A scientific statement from the American Heart Association. Circulation. 2014;129:1350–1369. doi:10.1161/ CIR.0000000000000019.