Ziegelstein Roy C, Meuchel Jennifer, Kim Thomas J, Latif Madiha, Alvarez William, Dasgupta Neela, Thombs Brett D
Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Md 21224-2780, USA.
Am J Med. 2007 Jun;120(6):525-30. doi: 10.1016/j.amjmed.2006.10.026. Epub 2007 Apr 30.
Selective serotonin reuptake inhibitors are commonly used to treat anxiety, depression, and other conditions that commonly affect patients with coronary artery disease. Selective serotonin reuptake inhibitors inhibit platelet activation and may, therefore, affect outcomes in patients with acute coronary syndromes.
A retrospective study was performed of 1254 patients with acute coronary syndromes comparing in-hospital bleeding and cardiac event rates in 158 patients who received a selective serotonin reuptake inhibitor and a propensity score-matched group of patients who did not. All patients were treated with a glycoprotein IIb/IIIa inhibitor and almost all also received aspirin, clopidogrel, and heparin.
Patients who received a selective serotonin reuptake inhibitor were significantly more likely to experience any bleeding (37.3% vs 26.6%, OR 1.65, 95% confidence interval (CI), 1.02-2.66, P =.04) and significantly less likely to experience recurrent myocardial ischemia, heart failure, or asymptomatic cardiac enzyme elevation while in the hospital (7.0% vs 13.9%, OR 0.46, 95% CI, 0.22-0.99, P =.04). No differences were observed in death, myocardial infarction during the hospitalization, urgent revascularization, or major bleeding. Bleeding and cardiac events were not affected by antidepressants other than selective serotonin reuptake inhibitors.
Selective serotonin reuptake inhibitor use during a hospitalization for an acute coronary syndrome is associated with reduced rates of recurrent ischemia, heart failure, or cardiac enzyme elevation at the expense of increased bleeding in patients receiving maximal conventional antiplatelet medications and heparin. Clinicians should be aware of this association when treating patients with an acute coronary syndrome.
选择性5-羟色胺再摄取抑制剂常用于治疗焦虑症、抑郁症以及其他常见于冠状动脉疾病患者的病症。选择性5-羟色胺再摄取抑制剂可抑制血小板活化，因此可能会影响急性冠脉综合征患者的预后。
对1254例急性冠脉综合征患者进行了一项回顾性研究，比较了158例接受选择性5-羟色胺再摄取抑制剂治疗的患者与倾向评分匹配的未接受该治疗的患者组的院内出血和心脏事件发生率。所有患者均接受糖蛋白IIb/IIIa抑制剂治疗，几乎所有患者还接受了阿司匹林、氯吡格雷和肝素治疗。
接受选择性5-羟色胺再摄取抑制剂治疗的患者发生任何出血的可能性显著更高（37.3%对26.6%，比值比1.65，95%置信区间[CI]，1.02 - 2.66，P = 0.04），而在住院期间发生复发性心肌缺血、心力衰竭或无症状心肌酶升高的可能性显著更低（7.0%对13.9%，比值比0.46，95%CI，0.22 - 0.99，P = 0.04）。在死亡、住院期间心肌梗死、紧急血运重建或大出血方面未观察到差异。除选择性5-羟色胺再摄取抑制剂外，其他抗抑郁药对出血和心脏事件无影响。
在急性冠脉综合征住院期间使用选择性5-羟色胺再摄取抑制剂与复发性缺血、心力衰竭或心肌酶升高发生率降低相关，但代价是接受最大剂量传统抗血小板药物和肝素治疗的患者出血增加。临床医生在治疗急性冠脉综合征患者时应知晓这种关联。
