Depression in Acute Coronary Syndrome Linked to Increased Major Adverse Cardiac Event Risk

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Study data indicate a significantly increased risk for MACE among patients with depressive disorder who have early or late stage ACS.

Depression was associated with increased risk for a major adverse cardiac event (MACE) among patients in the early or late phases of acute coronary syndrome (ACS), according to a study published in the Journal of Affective Disorders.

The study enrolled 1152 patients who had been hospitalized in Gwangju, South Korea, within 2 weeks of experiencing ACS during 2006 to 2012. At baseline, patients were treated for ACS and evaluated for depressive disorder. At 1 year after the index ACS, patients were re-evaluated for depressive disorder. All participants evaluated at 1 year were followed for incidence of MACE until 2017 or death. The primary endpoint was composite MACE, defined as the combined incidence of all-cause mortality, myocardial infarction, and percutaneous coronary intervention. Cox proportional hazards models were used to assess MACE risk among patients with and without depressive disorder. Analyses were adjusted for sociodemographic and clinical characteristics, including depression history and cardiovascular risk factors.

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Among 757 patients with complete follow-up data, 281 (37.1%) at baseline and 191 (25.2%) at follow-up had depressive disorder. Over the post-1-year follow-up period, composite MACE occurred in 246 patients (32.5%). Secondary outcomes were observed in 122 (16.1%) patients: 64 (8.5%) with cardiac death, 68 (9.0%) with myocardial infarction and 80 (10.6%) with percutaneous coronary intervention.

Depressive disorder at baseline or follow-up was significantly associated with both composite MACE and all MACE components. The highest incidence of MACE was observed among patients with depression at both baseline and 1-year follow-up (hazard ratio [HR], 6.12; 95% CI, 3.90-9.60; P <.001) compared with patients without depression. Patients with depression at baseline but not at follow-up (HR, 2.42; 95% CI, 1.56-3.78; P <.001) and patients with depression at follow-up but not at baseline (HR, 3.86; 95% CI, 2.55-5.83; P <.001) also experienced elevated incidence of MACE.

These data indicate a significantly increased risk for MACE among patients with depressive disorder and early or late stage ACS. As a limitation, investigators noted that depression evaluation was only conducted at a single time point rather than consistently over follow-up. These results emphasize the necessity of depression screening among patients with ACS to mitigate MACE risk.  

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures


Kim JM, Stewart R, Kim JW, et al. Impact of depression at early and late phases following acute coronary syndrome on long-term cardiac outcomes. J Affect Disord. 2019;260:592-596.