(IP173) Impact of Depression and Depression Medical Management on Outcomes after Lower Extremity Arterial Revascularization

Objectives: Several studies have demonstrated worse outcomes in patients with peripheral artery disease (PAD) who have comorbid depression. This study investigated the association of depression on outcomes in patients with PAD who have undergone lower extremity arterial revascularization procedures.

Methods: A retrospective cohort study at a single academic medical center was performed identifying patients aged 18 years and older with PAD who underwent an initial lower extremity revascularization procedure between January 1, 2007 and December 31, 2023. Demographic data, medical comorbidities, presence of comorbid depression and antidepressant medication use were recorded. Comorbid depression was defined as the patient having depression ICD codes 9 or 10 within 6 months of the index procedure. Outcomes evaluated included major adverse cardiac event (MACE) and major adverse limb event (MALE). Cox proportional hazards models were used to estimate the effect of comorbid depression and antidepressant use on MACE and MALE outcomes. Proportional hazards assumptions were assessed using Martingale-based residuals. Hazard ratio estimates were reported for predictor effects, along with corresponding Wald 95% confidence intervals and Type III Wald Chi square p-values. Model assumptions, residuals, and goodness-of-fit statistics were reviewed to ensure model fit.

Results: 1,595 patients were identified with 198 (12.4%) of patients having comorbid depression and 70 (4.4%) were taking antidepressant medication at the time of revascularization. Overall MACE was 9.6% and MALE was 7.6%. The odds of a MACE were lower for patients with comorbid depression than for patients without comorbid depression. The odds of a MALE did not vary significantly between patients with and without comorbid depression, seen in (Table I). Among patients with comorbid depression, the odds of a MACE or MALE did not vary significantly based on antidepressant use. (Table II).

Conclusions: Depression is a chronic illness present in PAD patients that has previously been associated with worse clinical outcomes. This study did not identify a significant association between comorbid depression or antidepressant use and MACE or MALE short-term outcomes following lower extremity revascularization. Future studies should focus on outcomes over an extended time, as short term outcomes may not be impacted. Further studies are warranted to investigate the impact of comorbid depression and depression medical treatment on long term outcomes in patients with PAD requiring revascularization.