Comparison of Recent Trends in Patients With and Without Major Depression and Acute ST-Elevation Myocardial Infarction

Depression has been associated with adverse outcomes after acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). However, trends over time in the incidence and inhospital treatment of STEMI for patients with co-morbid depression in the current era are unknown. We conducted a serial, cross-sectional analysis of patients with STEMI (weighted n = 3,057,998) in the National Inpatient Sample from 2003 to 2012. We examined trends in STEMI incidence and percutaneous coronary intervention (PCI) for patients with and without depression. We used multivariate logistic regression to assess observed differences and to explore trends in inhospital mortality. Depression was present in 153,180 (5%) of the sample. Patients with depression were more likely to be female (55% vs 37%), of white race (86% vs 78%), and had lower crude mortality (12.0% vs 14.2%; p <0.001 for all). Over time, STEMI incidence decreased 52% in patients without depression (p for trend <0.001) but remained stable in those with depression (p for trend 0.74). Although the use of PCI increased in all subgroups over the study duration (p for trend <0.001), depression was associated with lower adjusted odds of PCI (odds ratio 0.90, 95% confidence interval 0.89 to 0.92, p <0.001). In conclusion, in contrast to the wider population, the incidence of STEMI is not decreasing in patients with co-morbid depression. Patients with STEMI and co-morbid depression are less likely to receive revascularization therapy with PCI. These concerning differences warrant further attention.