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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
Open accessAbstract
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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“Follow-up from a cohort from the 12-month ESDEPACS trial (Escitalopram for Depression in Acute Coronary Syndrome) in 300 depressed patients after ACS found that those assigned to the escitalopram group had lower rates of major adverse cardiac events at 8 years compared with those receiving placebo (40.9% versus 53.6%; HR, 0.69 [95% CI, 0.49-0.96]). 178”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [178]
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“An exception is a recent study, which showed that among depressed patients with recent acute coronary syndrome, 24-week treatment with escitalopram compared with placebo resulted in a lower risk for a composite measure consisting of all-cause mortality, myocardial infarction, and percutaneous coronary intervention after a median of 8.1 years150.”
From Mechanisms and treatment of late-life depression (2019) · cites this paper as [150]
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Metadata
- 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
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2018-07-24
- Volume
- 320
- Issue
- 4
- Pages
- 350
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- 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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