Kim JM, et al. - A randomized, double-blind, placebo-controlled trial was conducted to examine how escitalopram treatment for depression impacts long-term major adverse cardiac events (MACE) in patients with recent acute coronary syndrome (ACS). Researchers reported that 24-week treatment with escitalopram vs placebo resulted in a lower risk of major adverse cardiac events after a median of 8.1 years among patients with depression following recent acute coronary syndrome.

Methods

• Participants in the study were 300 subjects with recent ACS and depression enlisted from May 2007 to March 2013, with follow-up completed in June 2017, at Chonnam National University Hospital, Gwangju, South Korea.
• For this investigation, 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.
• MACE, a composite of all-cause mortality, myocardial infarction (MI), and percutaneous coronary intervention (PCI) were the primary outcomes.
• The individual MACE components of all-cause mortality, cardiac death, MI, and PCI were the four secondary outcomes.
• They used Cox proportional hazards models to compare the escitalopram and placebo groups by time to first MACE.

Results

• The study results showed that among 300 randomized subjects (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.
• Data reported that MACE occurred in 61 subjects (40.9%) receiving escitalopram and in 81 (53.6%) receiving placebo (hazard ratio [HR], 0.69; 95% CI, 0.49-0.96; P=.03).
• It was noted that 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).