Acute Coronary Syndrome and Suicide: A Case‐Referent Study

Abstract

BackgroundThe high prevalence of acute coronary syndrome (ACS) represents a significant burden on healthcare resources. A robust association exists between depression and increased morbidity and mortality after ACS. This study examined the relationship between suicide and ACS after adjusting for depression and other comorbidities.Methods and ResultsIn this case‐referent study conducted in Taiwan, the cases were people aged 35 years or older who died from suicide between 2000 and 2012 and 4 live referents, each matched by age, sex, and area of residence. The covariates adjusted for in the analysis were sociodemographic characteristics, physical comorbidities, and psychiatric disorders. We identified 41 050 persons who committed suicide and 164 200 referents. In the case and referent groups, 1027 (2.5%) and 2412 (1.5%) patients had ACS, respectively. After potential confounders were adjusted, ACS was significantly associated with increased odds of suicide (aOR=1.15, 95% confidence interval [CI]=1.05‐1.26). The odds of suicide were highest during the initial 6 months post‐ACS diagnosis (OR=3.05, 95% CI=2.55‐3.65) and remained high for at least 4 years after ACS diagnosis.Conclusions ACS patients are at an increased risk of suicide compared with otherwise healthy people. The risk of suicide is particularly high in the 6 months after ACS diagnosis. Our results suggest that we need to identify efficacious methods to recognize those at risk for suicide and to develop effective interventions to prevent such deaths.

The association between heart diseases and suicide: a nationwide cohort study

“…The suicide rate associated with angina pectoris was highest within the first 6 months after diagnosis and for individuals with 2 or more comorbidities. Seemingly, this disorder has not previously been evaluated as an independent risk factor for suicide although one study reported that patients with acute coronary syndrome were at an increased risk of suicide when compared to otherwise healthy people. Acute coronary syndrome consists of ST‐segment elevation myocardial infarction, non‐ST‐segment elevation myocardial infarction, and unstable angina pectoris and the risk was particularly high in the first 6 months after a diagnosis of acute coronary syndrome .…”

“…Individuals diagnosed with HD were identified in the National Patient Register, which captures three types of medical contacts: inpatient admissions since 1977 as well as outpatient and emergency department contacts since 1995. Based on the existing evidence , we opted to examine the following HDs: heart failure, cardiomyopathy, acute myocardial infarction, subsequent myocardial infarction, cardiac arrest with successful resuscitation, atrial fibrillation and flutter, angina pectoris, ventricular tachycardia, acute pericarditis, atrioventricular and left bundle‐branch block. Individuals were considered as exposed from the date of first diagnosis.…”

“…Although heart disease (HD) in general has been linked to higher risks of suicide, conflicting findings have been reported . Specific HDs, such as heart failure , myocardial infarction and acute coronary syndrome , have been associated with suicide. The first month after a first diagnosis has been linked to an increased risk for individuals with heart failure or acute coronary syndrome .…”

“…Specific HDs, such as heart failure , myocardial infarction and acute coronary syndrome , have been associated with suicide. The first month after a first diagnosis has been linked to an increased risk for individuals with heart failure or acute coronary syndrome . Conclusive evidence regarding the association between the severity of HDs and suicide is lacking and although multiple admissions have been linked to higher risks of suicide , this might be considered a pseudo‐quantification of disease severity.…”

Interaction effects of diabetes and brain-derived neurotrophic factor on suicidal ideation in patients with acute coronary syndrome

“…Suicide is a global public health problem and is responsible for approximately 1 million deaths each year [1]. Acute coronary syndrome (ACS), which comprises unstable angina and myocardial infarction, is a serious life stressor that results in a high risk of suicidal behavior [2][3][4][5]. Moreover, suicidal ideation (SI) after ACS may be a risk factor for adverse cardiac outcomes [6].…”