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1 Supplementry Online Content Rieckmnn N, Kronish IM, Shpiro PA, Whng W, Dvidson KW. Serotonin reuptke inhibitor use, depression, nd long-term outcomes fter n cute coronry : prospective cohort study. JAMA Intern Med. Published online My 13, doi: /jminternmed efigure 1. Flow chrt, Prevlence of Antidepressnt Use nd Mjor Adverse Coronry Events/Mortlity Rtes efigure 2. Event-Rtes According to Prior Versus New-Onset Antidepressnt Use Compred to No Antidepressnt Use etble 1. Smple Chrcteristics According to Antidepressnt Mediction Sttus etble 2. Hzrd of 42-month Mjor Adverse Coronry Event/Mortlity mong Selective Serotonin Reuptke Inhibitor Users nd non-ssri Second-Genertion Antidepressnt Users Compred to No Antidepressnt Users (N=432) etble 3. Hzrd of 42-month Mjor Adverse Coronry Event/Mortlity ssocited with Prior versus New Onset Selective Serotonin Reuptke Inhibitor - nd Non-SSRI Second-Genertion Antidepressnt Use Compred with no Antidepressnt Use This supplementry mteril hs been provided by the uthors to give reders dditionl informtion bout their work.
2 etble 1. Smple Chrcteristics According to Antidepressnt Mediction Sttus No Antidepressnt (n = 354) Only Selective Serotonin Reuptke Inhibitor (n = 58) Only non-ssri Second- Genertion Antidepressnt (n = 20) P Vlue Women, No. (%) 125 (38.1) 30 (51.7) 12 (60.0).03 Age, y 61.4 (12.4) 59.2 (13) 57.6 (15.1).21 White, No. (%) 275 (77.7) 52 (89.7) 17 (85.0).09 Hispnic, No. (%) 34 (9.6) 6 (10.3) 2 (10.0).98 Current Smoker, No. (%) 60 (17.0) 11 (19.0) 5 (25.0).64 Admission dignosis Unstble Angin 151 (42.7) 35 (60.3) 10 (50.0).08 Non-ST segment elevtion myocrdil infrction 120 (33.9) 15 (25.9) 8 (40.0) ST segment elevtion myocrdil infrction 83 (23.4) 8 (13.8) 2 (10.0) Left ventriculr ejection frction <40%, No (%) 59 (16.7) 5 (8.6) 3 (15.0).29 Chrlson comorbidity index 1.2 (1.5) 1.7 (1.6) 1.7 (1.4).05 Dibetes, No. (%) 97 (27.4) 23 (39.7) 12 (60).002 Hypercholesterolemi, No. (%) 231 (68.1) 44 (78.6) 11 (57.9).16 Body Mss Index 29.8 (6.6) 31.3 (8.2) 29.8 (6.0).29 Globl Registry of Acute Coronry Events risk score b 90.6 (29.9) 91.4 (36.8) 89.4 (38.5).97 Beck Depression Inventory score t bseline 7.55 (8.26) (8.21) (11.20) <.001 c Beck Depression Inventory score 16 t bseline, No. (%) 37 (10.5) 13 (22.4) 3 (15.0).03 Mjor Depressive Disorder t bseline, No. (%) 24 (6.8) 12 (20.7) 6 (30) <.001 c History of Mjor Depressive Disorder, No. (%) 73 (21.4) 36 (64.3) 7 (38.9) <.001 c Mjor Depressive Disorder t 3 months, No. (%) 20 (6.3) 10 (18.2) 3 (16.7).006 Vlues re men (SD) unless otherwise indicted. b The Globl Registry of Acute Coronry Events risk score is n estblished composite prognostic score for mortlity nd mjor dverse crdic events fter Acute Coronry Syndromes. A description cn be found in previous rticle of the COPES cohort (8). Briefly, the risk score includes ge, history of myocrdil infrction nd hert filure, pulse rte nd systolic blood pressure t presenttion to hospitl, initil serum cretinine level, initil crdic enzyme level, ST-segment depression evident on electrocrdiogrm t presenttion, nd percutneous coronry intervention (PCI) performed in hospitl. Significnt difference between groups fter Bonferroni correction (α.003).
3 etble 2. Hzrd of 42-month Mjor Adverse Coronry Event/Mortlity mong Selective Serotonin Reuptke Inhibitor Users nd non-ssri Second-Genertion Antidepressnt Users Compred to No Antidepressnt Users (N=432) Predictors Hzrd Rtio (95% CI) P Vlue Model 1 Covrite-Adjusted Age 1.21 ( ).26 Femle 0.74 ( ).16 Non-white 1.37 ( ).22 Left ventriculr ejection frction < ( ).04 Chrlson comorbidity index 1.41 ( ) <.001 Globl Registry of Acute Coronry Events risk score 0.97 ( ).81 Index Admission ACS Dignosis Unstble ngin Non-ST segment elevtion myocrdil infrction 1.42 ( ).14 ST segment elevtion myocrdil infrction 0.87 ( ).64 Type of Antidepressnt Use Only selective serotonin reuptke inhibitor 2.12 ( ).04 Only non-ssri second-genertion ntidepressnt 0.97 ( ).95 Model 2: Covrite- nd Beck Depression Inventory-Adjusted No Antidepressnt Only selective serotonin reuptke inhibitor 1.83 ( ).02 Only non-ssri second-genertion ntidepressnt 0.86 ( ).78 Beck Depression Inventory Score 1.34 ( ).003 Model 3: Covrite- nd Mjor Depressive Episode-Adjusted [Reference] Only selective serotonin reuptke inhibitor 1.95 ( ).01 Only non-ssri second-genertion ntidepressnt 0.85 ( ).76 Mjor Depressive Episode 1.68 ( ).09 Adjusted for ge, sex, rce, Chrlson comorbidity index score, Globl Registry of Acute Coronry Events risk score, left ventriculr ejection frction, nd index dmission cute coronry dignosis
4 etble 3. Hzrd of 42-month Mjor Adverse Coronry Event/Mortlity ssocited with Prior versus New Onset Selective Serotonin Reuptke Inhibitor - nd Non-SSRI Second-Genertion Antidepressnt Use Compred with no Antidepressnt Use Predictors Hzrd Rtio (95% P CI) Model 1: All ntidepressnts versus no ntidepressnt use Antidepressnt prior to cute coronry 1.16 ( ).61 New onset ntidepressnt-use fter cute coronry 3.51 ( ).001 Beck Depression Inventory score 1.37 ( ).001 Model 2: Selective serotonin reuptke inhibitor versus no ntidepressnt use Selective serotonin reuptke inhibitor prior to cute coronry 1.48 ( ).19 New onset selective serotonin reuptke inhibitor-use fter 4.79 ( ).001 cute coronry Beck Depression Inventory score 1.33 ( ).005 Model 3: Non-SSRI second-genertion ntidepressnt versus no ntidepressnt use Non-SSRI second-genertion ntidepressnt use prior to cute 0.27 ( ).20 coronry New onset non-ssri second-genertion ntidepressnt-use 2.31 ( ).16 fter cute coronry Beck Depression Inventory score 1.36 ( ).004 Adjusted for ge, sex, rce, Chrlson comorbidity index score, Globl Registry of Acute Coronry Events risk score, left ventriculr ejection frction, nd bseline cute coronry dignosis
5 efigure 1. Flow chrt, Prevlence of Antidepressnt Use nd Mjor Adverse Coronry Events/Mortlity Rtes COPES prent smple (n = 457) Anlysis smple (n = 432) Excluded (n = 25) No bseline DISH dignosis (n = 4) Tricyclic ntidepressnt only (n = 8) Mjor dverse coronry event/mortlity (n=2) Monomine-oxidse inhibitor only (n=1) SSRI + tricyclic ntidepressnt (n=4) Mjor dverse coronry event/mortlity (n=4) SSRI + other second-genertion ntidepressnt (n=8) Mjor dverse coronry event/mortlity (n=8) Antidepressnt Use Not on ntidepressnt t bseline (n = 354) Only selective serotonin reuptke inhibitor t bseline (n = 58) Sertrline (N=24) Proxetine (N=13) Fluoxetine (N=11) Escitlprm (N=5) Citloprm (N=3) Citloprm + Escitloprm (N=1) Proxetine + Fluoxetine (N=1) Only non-ssri second-genertion ntidepressnt t bseline (n = 20) Buproprion (N=9) Trzodone (N=4) Venlfxine (N=3) Mirtzpine (N=1) Nefzodone + Bupropion (N=1) Trzodone + Bupropion (N=1) Venlfxine + Bupropion (N=1) 42 mo. Mjor Adverse Coronry Event/Mortlity Mjor dverse coronry event/mortlity (n = 76) Mjor dverse coronry event b (n=52) Mortlity b (n = 31) Mjor dverse coronry event/mortlity (n = 21) Mjor dverse coronry event b (n=14) Mortlity b (n = 9) Mjor dverse coronry event/mortlity (n = 4) Mjor dverse coronry event b (n=3) Mortlity b (n = 1)
6 Abbrevitions: COPES, Coronry Psychosocil Evlution Study; DISH, Depression Interview nd Structured Hmilton. in previous mnuscript (8), we hd reported tht totl of N=69 ptients of the COPES cohort were tking n SSRI t bseline. Since then, we found out tht one dditionl ptient who ws previously coded s tking non-ssri ntidepressnt hd, in fct, been tking n SSRI; thus, the totl number of ptients tking n SSRI is N=70. We rern our nlyses in the previous pper with the updted SSRI dt for this ptient which did not lter the findings from tht pper.
7 efigure 2. Event-Rtes According to Prior Versus New-Onset Antidepressnt Use Compred to No Antidepressnt Use 100 % Ptients With Mjor Adverse Coronry Event/Mortlity After 42 Months Use strted prior to cute coronry * 31.9 * 54.5 New prescription fter cute coronry 9.1 Use strted prior to cute coronry 33.3 New prescription fter cute coronry Selective serotonin reuptke inhibitor Non-SSRI secondgenertion ntidepressnt * P < 0.05
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