Antidepressant treatment in patients following acute coronary syndromes: a systematic review and Bayesian meta-analysis.

Sweda, Romy; Siontis, George C.M.; Nikolakopoulou, Adriani; Windecker, Stephan; Pilgrim, Thomas (2020). Antidepressant treatment in patients following acute coronary syndromes: a systematic review and Bayesian meta-analysis. (In Press). ESC Heart Failure Wiley 10.1002/ehf2.12861

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AIMS

The aim of this study is to investigate the effect of antidepressant therapy on mortality and cardiovascular outcomes in patients with acute coronary syndrome (ACS).

METHODS AND RESULTS

We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials and performed a Bayesian random-effects meta-analysis of randomized controlled trials that investigated antidepressant pharmacotherapy in patients following ACS. The primary outcome was all-cause mortality. Secondary outcomes were repeat hospitalizations and recurrent myocardial infarctions (MIs). Ten randomized controlled trials with a total of 1935 patients qualified for inclusion. Selective serotonin reuptake inhibitors were investigated in six, bupropion in three, and mirtazapine in one trial. Placebo was used as control in eight trials. There was no difference in all-cause mortality [odds ratio (OR) 0.97, 95% credible interval (CrI) 0.66-1.42] and recurrent MI (OR 0.64, 95% CrI 0.40-1.02) between patients receiving antidepressants compared with controls, whereas antidepressant therapy was associated with less repeat hospitalizations (OR 0.62, 95% CrI 0.40-0.94). In patients with ACS and concomitant depression, antidepressants reduced the odds of recurrent MI compared with usual care/placebo (OR 0.45, 95% CrI 0.25-0.81). Extended funnel plots suggest robustness of the observations.

CONCLUSIONS

Antidepressants in patients following ACS have no effect on mortality but reduce repeat hospitalizations; in patients with depression, there is a reduced risk of recurrent MI with antidepressant therapy.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research

UniBE Contributor:

Sweda, Romy; Siontis, Georgios; Nikolakopoulou, Adriani; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services
500 Science > 570 Life sciences; biology

ISSN:

2055-5822

Publisher:

Wiley

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

24 Sep 2020 14:47

Last Modified:

14 Oct 2020 19:16

Publisher DOI:

10.1002/ehf2.12861

PubMed ID:

32935927

Uncontrolled Keywords:

Acute coronary syndrome Antidepressants Depression Mental health Meta-analysis Myocardial infarction

BORIS DOI:

10.7892/boris.146641

URI:

https://boris.unibe.ch/id/eprint/146641

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