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Comment & Response
November 27, 2018

Cardiac Outcomes After Treatment for Depression in Patients With Acute Coronary Syndrome

Author Affiliations
  • 1Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
  • 2Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA. 2018;320(20):2151. doi:10.1001/jama.2018.15922

To the Editor In an extended follow-up of the Escitalopram for Depression in Acute Coronary Syndrome (EsDEPACS) trial, Dr Kim and colleagues randomized 300 patients with recent acute coronary syndrome (ACS) and major or minor depression to receive 24 weeks of escitalopram (n = 149) or placebo (n = 151) and reported significantly fewer major adverse cardiac events (MACE) a median of 8.1 years later in the escitalopram group.1 As noted by the authors, previous trials have not observed similar reductions in cardiac events or mortality. Kim and colleagues offered several possible explanations for these divergent findings, but several additional issues merit consideration.