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Escitalopram reduces risk of adverse cardiac events in adults with depression and acute coronary syndrome
Clinical Question
Does the treatment of depression with escitalopram in adults with recent acute coronary syndrome reduce the risk of subsequent major adverse cardiac events?
Bottom line
Treatment of depression with escitalopram in adults with recent acute coronary syndrome is significantly superior to placebo in reducing depressive symptoms. It also significantly reduces the risk of subsequent major adverse cardiac events (MACE). 1b-
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Government
Setting: Outpatient (specialty)
Synopsis
Escitalopram is effective in reducing depressive symptoms in clinically depressed adults following acute coronary syndrome, but it is uncertain if treatment also lowers the risk of subsequent MACE. These investigators analyzed long-term follow-up data from a 24-week randomized trial started in 2007 that evaluated the effect of escitalopram for treating depression in adults following acute coronary syndrome. Telephone contact with patients or their family members and information obtained from hospital records and death registries resulted in complete follow-up for all 300 participants for a median of 8.1 years. An independent endpoint committee masked to treatment group assignments assessed all outcomes. Using intention-to-treat analysis, MACE incidence (a composite of all-cause mortality, recurrent myocardial infarction, and percutaneous coronary intervention) occurred significantly less in the escitalopram group than in the placebo group (40.9% vs 53.6%, respectively; number needed to treat = 7.9; 95% CI 4.2 - 71.0). The difference was not significant, however, in the subgroup of patients with impaired left ventricular ejection fraction (< 55%) at baseline. Patients with a significant remission of their depression also had a significantly less risk of MACE than those without remission of their depression.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Another post-MI pill
“Great” to hear that these poor folks get another pill to add to their cereal bowl-full they receive post-MI. :-(
Hopefully there are also studies that investigate how to mitigate (or even prevent) the well known mood effects in cardiac patients. It seems that the faster they get to a cardiac rehab/education program, the more empowered they feel.
Seems to be in keeping with depression as a cardiac risk factor.
Does this make sense?
Good poem
Excellent