Abstract WMP98: Association Between Serotonin Receptor Antidepressant Use And 90-day Mortality After Acute Ischemic Stroke: Propensity Score Analysis Of 10-year Real-world Data

Abstract

Introduction: Post-stroke depression is associated with higher mortality. Unfortunately, the use of antidepressants (AD) as stroke treatment adjuvants has not been established due to a lack of placebo controls and concerns that selective serotonin reuptake inhibitor (SSRI) initiation after stroke may increase mortality. Methods: Using ICD-10 diagnosis/procedure, procedural terminology codes and medications, we identified index ischemic strokes (IS) with and without AD use (SSRIs, Serotonin Antagonist Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors) 1 year pre and post event, using deidentified pooled data from a 50 healthcare organization network (8/2011-7/2021). Non adult (<18 yrs) and intracerebral hemorrhage were excluded. AD and no AD patients were propensity score (PS) matched for demographic, comorbidity and clinical variables. Standardized mean difference (SMD) assessed match adequacy. Absolute Risk Difference (RD) and Risk Ratios (RR) with 95% Confidence Intervals (CI) were reported for 90-day mortality in the PS-matched sample. Kaplan-Meier (KM) analysis with log rank test (LRT) was performed. Results: Among 910,749 patients with an index IS, 634,599 met the inclusion criteria, of whom 136,219 (21.5%) had AD use before and after IS. Significant pre-match differences in demographic and clinical parameters were observed between the AD and no-AD groups (table). PS algorithm generated a 1:1 optimally matched sample (95% SMD reduction) of 78,815 AD and no AD IS patients each, with significant covariate differences for female sex, mood disorder diagnosis, systolic blood pressure and cardiovascular medication use (table). In the matched sample, the 90-day mortality risk post-IS was significantly lower in the AD group. RD: -3.4%, RR(CI) 0.54(0.52-0.56). LRT P<0.0001, KM curve shown in the graphic. Conclusion: AD utilization before and after IS demonstrates significantly lower 90-day mortality in real world multicenter data.