Acute Coronary Syndrome

and Suicide: A CaseReferent Study

T. Fadli nazwan sani
Adrian Arief
Sri Ayu Mulia
Nurul Husna
Indah Aulia Irsa Siregar

Pembimbing:
dr. Muhammad Muqsith, Sp.JP-FIHA

Background
The high prevalence of acute coronary

syndrome (ACS) represents a significant

burden on healthcare resources.
Arobust association exists between
depression and increased morbidity and
mortality after ACS.
This study examined the relationship
between suicide and ACS after adjusting for
depression and other comorbidities.

Methods
Data Source

from the HWDC of the Department of

Health
HWDC provides medical information on
inpatients and outpatients (sex, date of
birth, dates of admission and discharge,
services received from medical institutions,
and medication records).

Study Population

Case Group
The National Mortality Registry (NMR) data
set, included persons who died from suicide
between January 1, 2000 and December 31,
2012, in the case group.
The NMR contains the records of all deaths
and has been maintained by the Department
of Health of Taiwan since 1981

Referent Group
Group was randomly matched at a ratio of

1:4 to the study group by age, sex, and

area of residence by applying
The incidence density sampling method.
In the referent group included those who
were still alive at the matched index date
but could still become suicide cases in the
following years if they committed suicide.

Acute Coronary Syndrom

ACS was defined according to the current

2007 American College of

Cardiology/American Heart Association
guidelines20: electrocardiographic changes
consistent with ACS and serial increases in
patients who received a diagnosis of STEMI,
non-STEMI, or unstable angina pectoris
according to standardized criteria.

Potential Confounders
Potential confounders because they are

potentially associated factors for suicide and

ACS: hypertension, diabetes , dyslipidemia ,
cerebrovascular disease, congestive heart
failure, chronic kidney disease, chronic
obstructive pulmonary disease, and cancer.
Furthermore, we adjusted for the following
psychiatric comorbidities because of their
close association with suicide: depressive
disorders , substance use disorders, anxiety
disorders , mood disorders, and psychoticrelated disorders.

Statistical Analyses
We employed conditional logistic regression

to investigate the association between risk

factors and suicide by a matched casereferent design.
Crude odds ratios (ORs), adjusted ORs
(aORs), and 95% confidence intervals
using SAS Version 9.3 (SAS Institute, Inc,
1995, Cary, NC). P values of <0.05 were
considered statistically significant.