Effectiveness of Paroxetine Versus Non-Paroxetine Selective Serotonin Reuptake Inhibitors on Mortality and Heart Failure Following Myocardial Infarction: An Active Comparator Population-Based Cohort Study.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY

Pharmacoepidemiology and Drug Safety Pub Date : 2025-04-01 DOI:10.1002/pds.70141

Thomas Ravn Lassen, Péter Szentkúti, Henrik Toft Sørensen, Hans Erik Bøtker, Jens Sundbøll

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引用次数: 0

Abstract

Background: Animal studies suggest that paroxetine, unlike other selective serotonin reuptake inhibitors (SSRIs), may attenuate post-myocardial infarction (MI) heart failure. We examine the effectiveness of paroxetine versus non-paroxetine SSRIs on the risk of post-MI mortality and heart failure in a clinical setting.

Method: We conducted a nationwide population-based cohort study based on Danish medical registries. Using an active comparator design, we compared the effectiveness of paroxetine with non-paroxetine SSRI drugs on post-MI outcomes. This included all patients hospitalized for MI in Denmark during 1995-2020 who had redeemed an SSRI prescription within 90 days prior to admission and measured outcome variables after a 180-day follow-up period. We calculated cumulative incidences as a measure of risk and used Cox regression to compute hazard ratios (HRs) for all outcomes, adjusting for sex, age group, individual comorbidities, and comedications.

Results: We identified 13 053 patients receiving treatment with an SSRI at the time of hospital admission for MI. Cumulative incidences were lower for paroxetine SSRI users compared with non-paroxetine SSRI users for all-cause mortality (24.7% versus 33.8% (difference: -9.1% [95% CI: -12.4; -5.8])) and cardiovascular death (15.9% versus 22.7% (-6.8% [95% CI: -9.6; -4.0])), but not for heart failure (11.0% versus 11.8% (-0.7% [95% CI: -3.13; 1.65])). Adjusted hazard ratios (aHRs) showed no substantial differences for all-cause mortality (aHR 0.9 [95% CI: 0.8-1.1]), cardiovascular death (aHR 0.9 [95% CI: 0.8-1.1]), or heart failure (aHR 1.0 [95% CI: 0.8-1.3]).

Conclusion: Paroxetine was not associated with clinically significant improvement in post-MI outcomes compared with non-paroxetine SSRI drugs.

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帕罗西汀与非帕罗西汀选择性血清素再摄取抑制剂对心肌梗死后死亡率和心力衰竭的有效性：一项基于人群的有效比较队列研究

动物研究表明，与其他选择性5 -羟色胺再摄取抑制剂（SSRIs）不同，帕罗西汀可以减轻心肌梗死后（MI）心力衰竭。我们研究了帕罗西汀与非帕罗西汀SSRIs在临床环境中对心肌梗死后死亡率和心力衰竭风险的有效性。方法：我们进行了一项基于丹麦医疗登记的全国性人群队列研究。采用主动比较设计，我们比较了帕罗西汀与非帕罗西汀SSRI药物对心肌梗死后结局的有效性。这包括1995-2020年期间在丹麦因心肌梗死住院的所有患者，他们在入院前90天内赎回了SSRI处方，并在180天的随访期后测量了结果变量。我们计算了累积发生率作为风险度量，并使用Cox回归计算了所有结果的风险比（hr），调整了性别、年龄组、个体合并症和药物。结果：我们确定了13 053例因心肌梗死入院时接受SSRI治疗的患者。与非帕罗西汀SSRI使用者相比，帕罗西汀SSRI使用者的全因死亡率累积发生率较低（24.7%比33.8%）(差异：-9.1% [95% CI: -12.4；-5.8])和心血管死亡(15.9%对22.7% (-6.8% [95% CI: -9.6；-4.0]))，但心力衰竭没有(11.0%对11.8% (-0.7% [95% CI: -3.13；1.65]))。调整后的危险比（aHRs）在全因死亡率（aHR 0.9 [95% CI: 0.8-1.1]）、心血管死亡（aHR 0.9 [95% CI: 0.8-1.1]）或心力衰竭（aHR 1.0 [95% CI: 0.8-1.3]）方面没有显著差异。结论：与非帕罗西汀类SSRI药物相比，帕罗西汀与心肌梗死后预后的临床显著改善无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.