Prevalence and risk of type 2 myocardial infarction (T2MI) in adults with depression and its impact on in-hospital outcomes: a nationwide population-based analysis in the USA (2019)
Authors: Brereton B , Tankasala S , Ghumare I , Nunez F , Ashfaque M , James A , Bandaru R R , Ghanathe P , Shaik S , Singh S , Jain A , Desai R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Type 2 myocardial infarction (T2MI) is an ischaemic myocardial injury in the context of oxygen supply/demand mismatch in the absence of a primary coronary event. However, though there is a rising prevalence of depression and its potential association with T1MI, data remains non-existent to evaluate the association with T2MI. Therefore, we aim to identify the prevalence and risk of T2MI in adults with depression and its impact on the in-hospital outcomes.

Methods
We queried the National Inpatient Sample (2019) to identify T2MI hospitalizations using ICD-10 codes in hospitalized adults ( ≥18 years). In addition, we compared sociodemographics and comorbidities in the T2MI cohort with vs. without comorbid depression. Finally, we used multivariate regression analysis to study the odds of T2MI hospitalizations with vs. without depression and in-hospital outcomes (all-cause mortality, cardiogenic shock, cardiac arrest, and stroke); adjusting for confounders. Statistical significance was achieved with p-value of &lt;0.05.

Results
There were 331,145 adult T2MI hospitalizations after excluding T1MI (median age 73 years, 52.8% male, 69.9% white); 41,405 (12.5%) had depression, the remainder; 289,740 did not have depression. Multivariate analysis revealed lower odds of T2MI in patients with depression vs without (aOR 0.88, 95% CI 0.86-0.90, p= 0.001).There was equal prevalence of prior MI with any revascularization and similar prevalence of peripheral vascular disease in cohort with depression vs without depression. There is a greater prevalence of stroke in patients with depression 10.1% vs those without 8.6 %. There was a slightly higher prevalence of hyperlipidaemia in patients with depression vs without depression; (56.5% vs 48.9%), as well as obesity (21.3% vs 17.9%) There was generally equal prevalence of HTN and T2DM in both cohorts. There was no significant difference in the frequency of elective and non-elective admissions between cohorts. Patients with depression vs without depression also showed a lower risk of all-cause mortality (aOR 0.75, 95%CI 0.67-0.83, p= 0.001), Cardiogenic shock (aOR 0.65, 95%CI 0.56-0.76, p= 0.001), Cardiac arrest (aOR 0.77, 95%CI 0.67-0.89, p= 0.001) as well as Stroke (aOR 0.79, 95%CI 0.70-0.89, p= 0.001).

Conclusions
This study revealed a significantly lower risk of T2MI in patients with depression vs. without depression. The data also showed a significant decrease in adverse in-hospital outcomes such as all-cause mortality, cardiogenic shock, cardiac arrest and stroke in patients with depression vs. without depression. Further prospective studies are warranted to assess the impact of depression on other in-hospital outcomes as well as the impact of medication, its duration and serotonin levels on T2MI.