Treatment with escitalopram shortly after acute coronary syndrome (ACS) resulted in lower risk for major adverse cardiac events, according to research published in JAMA.
Depression is associated with poorer outcomes in ACS and these findings suggest that this course of treatment may improve long-term major adverse cardiac event (MACE) outcomes.
The randomized, double-blind, placebo-controlled trial enrolled 300 patients with recent ACS and depression at Channam National University Hospital in Gwangju, South Korea (ClinicalTrials.gov identifier: NCT00419471). The patients were randomly assigned to receive escitalopram or a matched placebo for 24 weeks. Patients completed a median of 8.1 years of follow-up. Researchers assessed the effect of escitalopram treatment for depression on long-term MACE via Cox proportional hazards models.
MACE occurred in 61 patients (40.9%) receiving escitalopram and 81 (53.6%) receiving a placebo. Incidence of all-cause mortality was 20.8% in the escitalopram group vs 24.5% in the placebo group, 10.7% vs 13.2% for cardiac death, 8.7% vs 15.2% for myocardial infarction, and 12.8% vs 19.9% for percutaneous coronary intervention, respectively. “Treatment with escitalopram for depression following recent acute coronary syndrome may improve long-term cardiac outcomes,” concluded the researchers, although they added that further research is needed.
The single site recruitment for the study may limit the generalizability of the findings. The population enrolled was exclusively Korean. Additional limitations included the small number of participants experiencing individual MACE components and that no data was collected on depression or antidepressant use after the 1-year follow-up. Differential attrition should also be considered, as attrition was associated with higher serum creatine kinase muscle-brain levels in the subgroup of individuals completing the trial.
Kim JM, Stewart R, Lee YS, et al. Effect of escitalopram vs placebo treatment on long-term cardiac outcomes in patients with acute coronary syndrome: a randomized clinical trial. JAMA. 2018;320(4):350-357.