Background and Hypothesis People with severe mental illness (SMI) may experience excess mortality and inequitable treatment following acute coronary syndrome (ACS). However, cardioprotective pharmacotherapy and SMI diagnoses other than schizophrenia are rarely examined in previous reviews. We hypothesized that SMI including bipolar disorder (BD) is associated with increased post-ACS mortality, decreased revascularization, and cardioprotective medication receipt relative to those without SMI. Study Design We performed a meta-analysis to quantitatively synthesize estimates of post-ACS mortality, major adverse cardiac events (MACEs), and receipt of invasive coronary procedures and cardioprotective medications in patients with SMI, comprising schizophrenia, BD, and other nonaffective psychoses, relative to non-SMI counterparts. Subgroup analyses stratified by SMI subtypes (schizophrenia, BD), incident ACS status, and post-ACS time frame for outcome evaluation were conducted. Study Results Twenty-two studies were included (n = 12 235 501, including 503 686 SMI patients). SMI was associated with increased overall (relative risk [RR] = 1.40 [95% confidence interval = 1.21–1.62]), 1-year (1.68 [1.42–1.98]), and 30-day (1.26 [1.05–1.51]) post-ACS mortality, lower receipt of revascularization (odds ratio = 0.57 [0.49–0.67]), and cardioprotective medications (RR = 0.89 [0.85–0.94]), but comparable rates of any/specific MACEs relative to non-SMI patients. Incident ACS status conferred further increase in post-ACS mortality. Schizophrenia was associated with heightened mortality irrespective of incident ACS status, while BD was linked to significantly elevated mortality only in incident ACS cohort. Both schizophrenia and BD patients had lower revascularization rates. Post-ACS mortality risk remained significantly increased with mild attenuation after adjusting for revascularization. Conclusions SMI is associated with increased post-ACS mortality and undertreatment. Effective multipronged interventions are urgently needed to reduce these physical health disparities.

中文翻译：

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严重精神疾病患者急性冠脉综合征后的死亡率、血运重建和心脏保护药物治疗：系统评价和荟萃分析

背景和假设患有严重精神疾病（SMI）的人在急性冠状动脉综合征（ACS）后可能会经历过高的死亡率和不公平的治疗。然而，除精神分裂症之外的心脏保护药物治疗和 SMI 诊断在之前的综述中很少被检查。我们假设，与没有 SMI 的患者相比，包括双相情感障碍 (BD) 在内的 SMI 与 ACS 后死亡率增加、血运重建减少和心脏保护药物接受相关。研究设计我们进行了一项荟萃分析，以定量综合对 SMI 患者（包括精神分裂症、双相情感障碍和其他非情感性精神病）的 ACS 后死亡率、主要不良心脏事件 (MACE) 以及接受侵入性冠状动脉手术和心脏保护药物的估计。相对于非 SMI 同行。进行了按 SMI 亚型（精神分裂症，BD）、ACS 事件状态和 ACS 后结果评估时间范围分层的亚组分析。研究结果 纳入 22 项研究（n = 12 235 501，其中 503 686 名 SMI 患者）。SMI 与总体风险（相对风险 [RR] = 1.40 [95% 置信区间 = 1.21–1.62]）、1 年风险（1.68 [1.42–1.98]）和 30 天风险（1.26 [1.05–1.51]）增加相关。 ACS 后死亡率、接受血运重建（比值比 = 0.57 [0.49–0.67]）和心脏保护药物（RR = 0.89 [0.85–0.94]）较低，但与非 SMI 患者相比，任何/特定 MACE 的发生率相当。事件 ACS 状态导致 ACS 后死亡率进一步增加。无论发生的 ACS 状态如何，精神分裂症都与死亡率升高相关，而 BD 仅在 ACS 事件队列中与死亡率显着升高相关。精神分裂症和双相情感障碍患者的血运重建率均较低。调整血运重建后，ACS 后死亡风险仍然显着增加，并略有减弱。结论 SMI 与 ACS 后死亡率增加和治疗不足相关。迫切需要采取有效的多管齐下的干预措施来减少这些身体健康差异。