Coronary artery disease in adults with schizophrenia: Anatomy, treatment and outcomes

Abstract

Background: People with schizophrenia are at significantly greater risk of cardiovascular disease-related mortality. We set out to determine if people with and without schizophrenia who undergo coronary artery catheterization differ with respect to coronary anatomy, coronary artery disease management, or outcome. Methods and results: This study used provincial administrative data and a clinical registry that included all individuals who undergo coronary catheterization in Alberta, Canada. Individuals with schizophrenia were identified in hospital discharge data using ICD-9 codes. We identified 271 Albertans with a hospital discharge diagnosis of schizophrenia and a subsequent coronary catheterization and were matched with 1083 controls without schizophrenia that had undergone a coronary catheterization. Extent of coronary disease was assessed using 1) left ventricular ejection fraction; 2) the Duke Jeopardy Score (a valid measure of myocardium at risk for ischemic injury); and 3) a categorical assessment of coronary anatomy risk. People with schizophrenia were less likely to be categorized as high risk on the Duke coronary index (p b .005) and more likely to be categorized as having a normal coronary anatomy (p b .05). Significant differences in mortality were found among those with and without schizophrenia both before and after adjustment for clinical differences. Conclusions: Our results suggest that people with schizophrenia have less severe coronary atherosclerosis, and are less likely to receive revascularization. Despite less severe coronary atherosclerosis, individuals with schizophrenia had a significantly higher mortality following catheterization. Interventions to increase therapeutic adherence and clinical follow up of patients with mental illness may improve health outcomes.

Cardiac surgery for patients with schizophrenia: clinical experience of six patients

“…Finally, medication management is also an important factor because this affects the surgical treatment plan. It has been reported that approximately one-third of outpatients with schizophrenia are unable to manage their medications properly [20]. In fact, similar cases were found in this report.…”

“…Postoperative course. The mean observation period was 1510.6 ± 1430.1 (140-4068) days, the mean post-operative hospital stay was 17.8 ± 3.5 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)) days, and there was no mortality (within 30 days after surgery). The post-operative complications included paroxysmal atrial fibrillation (n = 1) and delirium (n = 1); however, no fatal complications occurred [Table 3].…”