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Revascularization rate is lower in schizophrenic patients with acute myocardial infarction

Key clinical point: Coronary revascularization rate is substantially lower in patients with schizophrenia and acute myocardial infarction (AMI) as compared with patients without schizophrenia, which may possibly explain the higher-than-expected mortality in this population.

Major finding: Revascularization was significantly lower in patients with AMI and schizophrenia vs. those without (odds ratio [OR], 0.48; P less than .001). Results were consistent for percutaneous coronary interventions (OR, 0.48; P less than .001) and coronary artery bypass grafts (OR, 0.61; P less than .001).

Study details: Meta-analysis of 6 follow-up studies including 3,260,754 hospitalized patients with AMI with 17,875 having a prior diagnosis of schizophrenia.

Disclosures: No study sponsor was identified. The authors declared no conflict of interest.

Commentary

People with serious mental illnesses such as schizophrenia die, on average, one to two decades earlier than the general population. While causes of premature mortality are varied, a substantial, and potentially modifiable, proportion of cases are due to cardiovascular disease and complications such as acute myocardial infarction (AMI). This meta-analysis found that individuals with schizophrenia are less likely to have revascularization procedures such coronary artery bypass grafts post-AMI, compared to individuals who do not have schizophrenia. Limited access to post-AMI procedures likely further contributes to down-stream mortality risk. Having an AMI is a frightening and sobering experience for anyone. The findings of this report suggest a need for care approaches that can help individuals with schizophrenia and recent AMI to get the care and support they need to access medical care that is appropriate and may reduce early mortality risk.”

Martha Sajatovic, MD

Professor of Psychiatry and of Neurology

WillardBrown Chair in Neurological Outcomes Research

Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center

Case Western Reserve University School of Medicine

Citation:

Shao M et al. Prog Neuropsychopharmacol Biol Psychiatry. 2020 Jan 16. doi: 10.1016/j.pnpbp.2020.109870.