Abstract Body: Background: Limited evidence exists on the role of depression in the risk of developing stroke and other cardiovascular outcomes in post-percutaneous coronary interventions (PCI) patients. We investigated this relationship using data from the Korean National Health Insurance Service database.

Methods: Our nationwide retrospective cohort study included 164,198 patients who underwent PCI between 2010-2017. Depression was defined using the ICD-10 codes recorded prior to the PCI event. The primary outcome was a new-onset stroke following the PCI. Secondary outcomes included PCI with myocardial infarction, revascularization (PCI or coronary artery bypass grafting), and all-cause mortality. A multivariable Cox proportional hazards regression analysis was employed to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), adjusting for potential confounders, including sociodemographic and lifestyle factors, comorbidities, and myocardial infarction at the index PCI.

Results: Over a median follow-up of 5.0 years, acute stroke occurred in 5.7% of patients with a pre-existing depression (17.4% of the study population), compared to 3.5% of those without depression. Depression was associated with a 27% increased risk of acute stroke (aHR 1.27, 95% CI 1.20-1.35). Additionally, depression was linked with a 25% elevated risk of all-cause death (aHR 1.25, 95% CI, 1.21-1.29) and an 8% increased risk of revascularization (aHR 1.08, 95% CI 1.04-1.11). The associations with the risk of stroke and all-cause mortality were stronger in those under 65 years.

Conclusions: Our findings suggest that pre-existing depression may increase the risk of stroke and all-cause mortality after PCI, particularly in individuals under 65 years. Additionally, depression was significantly associated with an increased need for revascularization. This underscores the potential benefits of managing depression to reduce stroke risk and overall cardiovascular outcomes following PCI.