Impact of depression on in-hospital outcomes for adults with type 2 myocardial infarction: A United States population-based analysis.

Background: Type 2 myocardial infarction (T2MI) is an ischemic 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 type 1 myocardial infarction (T1MI), data remains non-existent to evaluate the association with T2MI.

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 Internal Classification of Diseases-10 codes in hospitalized adults (≥ 18 years). In addition, we compared sociodemographic and comorbidities in the T2MI cohort with without comorbid depression. Finally, we used multivariate regression analysis to study the odds of T2MI hospitalizations with without depression and in-hospital outcomes (all-cause mortality, cardiogenic shock, cardiac arrest, and stroke), adjusting for confounders. Statistical significance was achieved with a value of < 0.05.

Results: There were 331145 adult T2MI hospitalizations after excluding T1MI (median age: 73 years, 52.8% male, 69.9% white); 41405 (12.5%) had depression, the remainder; 289740 did not have depression. Multivariate analysis revealed lower odds of T2MI in patients with depression without [adjusted odds ratio (aOR) = 0.88, 95% confidence interval (CI): 0.86-0.90, = 0.001]. There was the equal prevalence of prior MI with any revascularization and a similar prevalence of peripheral vascular disease in the cohorts with depression without depression. There is a greater prevalence of stroke in patients with depression (10.1%) those without (8.6%). There was a slightly higher prevalence of hyperlipidemia in patients with depression without depression (56.5% 48.9%), as well as obesity (21.3% 17.9%). There was generally equal prevalence of hypertension and type 2 diabetes mellitus in both cohorts. There was no significant difference in elective and non-elective admissions frequency between cohorts. Patients with depression without depression also showed a lower risk of all-cause mortality (aOR = 0.75, 95%CI: 0.67-0.83, = 0.001), cardiogenic shock (aOR = 0.65, 95%CI: 0.56-0.76, = 0.001), cardiac arrest (aOR = 0.77, 95%CI: 0.67-0.89, = 0.001) as well as stroke (aOR = 0.79, 95%CI: 0.70-0.89, = 0.001).

Conclusion: This study revealed a significantly lower risk of T2MI in patients with depression compared to patients without depression by decreasing adverse in-hospital outcomes such as all-cause mortality, cardiogenic shock, cardiac arrest, and stroke in patients with depression.