Reduced rate of revascularization in schizophrenic patients with acute myocardial infarction: A systematic review and meta-analysis

Importance: It has been suggested that patients with schizophrenia have higher than expected mortality following acute coronary events. However, the in-hospital revascularization rate in patients with schizophrenia and acute myocardial infarction (AMI) compared to mentally healthy patients remains unknown. Objective: To evaluate the revascularization rate in schizophrenic patients after AMI with a meta-analysis of observational studies. Data sources: PubMed and Embase electronical databases. Study selection: Observational studies that evaluate the likelihood of revascularization in AMI patients with schizophrenia compared to those without schizophrenia, after adjustment for potential influencing factors. Data extraction and synthesis: Data regarding study design, characteristics of the AMI patients and schizophrenic patients, and strategies of revascularization were extracted. Results were pooled and analyzed with a random effect model to incorporate the potential heterogeneity. Main outcome and measures: The likelihood of revascularization in AMI patients with schizophrenia compared to those without schizophrenia, after adjustment for potential influencing factors. Results: Overall, 3,260,754 hospitalized AMI patients from six follow-up studies were included, of which 17,875 patients had a prior diagnosis of schizophrenia. Results of this meta-analysis suggest that revascularization was significantly lower in AMI patients with schizophrenia compared to those without schizophrenia (odds ratio [OR]: 0.48, 95% confidence interval [CI]: 0.38 to 0.62, p < .001; I-2 = 93%), after adjustment for demographic characteristics, comorbidities, and hospital and regional factors. Specifically, AMI patients with schizophrenia had significantly fewer percutaneous coronary interventions (OR: 0.48, 95% CI: 0.41 to 0.56, p < .001; I-2 = 49%) and coronary artery bypass grafts (OR: 0.61, 95% CI: 0.53 to 0.70, p < .001; I-2 = 20%) compared to those without schizophrenia. Conclusions and relevance: Patients with schizophrenia and AMI have a lower rate of coronary revascularization as compared with patients without schizophrenia, which is an important cause of higher-than-expected mortality rate in this population.