Cited by 204Cardiac Health and Mental HealthAcute Myocardial Infarction ResearchTreatment of Major Depression

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Effect of Escitalopram vs Placebo Treatment for Depression on Long-term Cardiac Outcomes in Patients With Acute Coronary Syndrome: A Randomized Clinical Trial

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Kim, Jae-Min, Stewart, Robert, Lee, Yong-Seong, Lee, Hee-Joon, Kim, Min Chul, Kim, Ju-Wan, Kang, Hee-Ju, Bae, Kyung-Yeol, Kim, Sung-Wan, Shin, Il-Seon, Hong, Young Joon, Kim, Ju Han, Ahn, Youngkeun, Jeong, Myung Ho, Yoon, Jin-Sang·2018·JAMA

DOI 10.1001/jama.2018.9422PMC PMC6583706

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Abstract

Importance: Depression has been associated with poorer medical outcomes in acute coronary syndrome (ACS), but there are few data on the effects of antidepressant treatment on long-term prognosis. Objective: To investigate the effect on long-term major adverse cardiac events (MACE) of escitalopram treatment of depression in patients with recent ACS. Design, Setting, and Participants: Randomized, double-blind, placebo-controlled trial conducted among 300 patients with recent ACS and depression enrolled from May 2007 to March 2013, with follow-up completed in June 2017, at Chonnam National University Hospital, Gwangju, South Korea. Interventions: Patients were randomly assigned to receive either escitalopram in flexible dosages of 5, 10, 15, or 20 mg/d (n = 149) or matched placebo (n = 151) for 24 weeks. Main Outcomes and Measures: The primary outcome was MACE, a composite of all-cause mortality, myocardial infarction (MI), and percutaneous coronary intervention (PCI). Four secondary outcomes were the individual MACE components of all-cause mortality, cardiac death, MI, and PCI. Cox proportional hazards models were used to compare the escitalopram and placebo groups by time to first MACE. Results: Among 300 randomized patients (mean age, 60 years; 119 women [39.3%]), 100% completed a median of 8.1 (interquartile range, 7.5-9.0) years of follow-up. MACE occurred in 61 patients (40.9%) receiving escitalopram and in 81 (53.6%) receiving placebo (hazard ratio [HR], 0.69; 95% CI, 0.49-0.96; P = .03). Comparing individual MACE outcomes between the escitalopram and placebo groups, respectively, incidences for all-cause mortality were 20.8% vs 24.5% (HR, 0.82; 95% CI, 0.51-1.33; P = .43), for cardiac death, 10.7% vs 13.2% (HR, 0.79; 95% CI, 0.41-1.52; P = .48); for MI, 8.7% vs 15.2% (HR, 0.54; 95% CI, 0.27-0.96; P = .04), and for PCI, 12.8% vs 19.9% (HR, 0.58; 95% CI, 0.33-1.04; P = .07). Conclusions and Relevance: Among patients with depression following recent acute coronary syndrome, 24-week treatment with escitalopram compared with placebo resulted in a lower risk of major adverse cardiac events after a median of 8.1 years. Further research is needed to assess the generalizability of these findings. Trial Registration: ClinicalTrials.gov Identifier: NCT00419471.

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Authors: Kim, J.-M., Stewart, R., Lee, Y.-S., Lee, H.-J., Kim, M. C., Kim, J.-W., Kang, H.-J., Bae, K.-Y., Kim, S.-W., Shin, I.-S., Hong, Y. J., Kim, J. H., Ahn, Y., Jeong, M. H., & Yoon, J.-S.
Affiliations: Chonnam National University (KR)
King's College London (GB)
Department of Psychiatry, Chonnam National University Medical School, Republic of Korea
Department of Cardiology, Chonnam National University Medical School, Republic of Korea
Corresponding author: Kim, Jae-Min
ORCID: Kim, Jae-Min
Stewart, Robert
Kang, Hee-Ju
Shin, Il-Seon
Hong, Young Joon
Ahn, Youngkeun
Jeong, Myung Ho
Yoon, Jin-Sang
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2018-07-24
Volume: 320
Issue: 4
Pages: 350
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2018.9422
PMC: PMC6583706
OpenAlex: W2884872821
Cited by: 204
References: 44
Citations by year: 2026: 15 · 2025: 26 · 2024: 22 · 2023: 22 · 2022: 29 · 2021: 24 · 2020: 24 · 2019: 28 · 2018: 13
FWCI: 16.84
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Research Portal (King's College London) (submittedVersion)
Funders: King's College London
Ministry of Science, ICT and Future Planning
National Research Foundation of Korea
Medical Research Council (MC_PC_17214)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Keywords: escitalopram, depression, acute coronary syndrome, major adverse cardiac events, antidepressant treatment, all-cause mortality, myocardial infarction, percutaneous coronary intervention, cardiovascular mortality, long-term prognosis, depression and cardiovascular risk, flexible dosing, depression screening in pregnancy, depression screening
MeSH terms: Adult, Aged, Depression, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Risk, Citalopram, Incidence, Proportional Hazards Models, Antidepressive Agents, Second-Generation, Acute Coronary Syndrome, Percutaneous Coronary Intervention

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Effect of Escitalopram vs Placebo Treatment for Depression on Long-term Cardiac Outcomes in Patients With Acute Coronary Syndrome: A Randomized Clinical Trial

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