1 Department of Pharmacy, Mackay Memorial Hospital, Taipei, Taiwan.
2 Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
J Psychopharmacol. 2017 Dec;31(12):1544-1555. doi: 10.1177/0269881117714047. Epub 2017 Jun 14.
Associations between antipsychotic agent (AP) use and myocardial infarction (MI) risk have been inconsistent and remain controversial. We therefore conducted a meta-analysis of observational studies to address this knowledge gap.
Detailed electronic database searches were performed to identify reports of observational studies that evaluated the association between AP use and the risk of MI. Pooled odds ratios (ORs) were calculated using random or fixed-effects models.
In total, four case-control studies, two case-crossover studies, one case-case time control study, three cohort studies, and one self-controlled case series were included. The pooled OR (95% confidence interval (CI)) between any AP use and MI risk was 1.55 (1.33-1.79) compared with non-use: 1.39 (1.06-1.82) for atypical AP use and 1.57 (1.29-1.91) for typical AP use. Subgroup analyses indicated that male gender, schizophrenia diagnosis, and AP exposure periods ≤60 days were associated with higher risk of MI.
Current evidence, based on 10 observational studies, suggested that AP use might be a potential risk factor of MI. However, we cannot conclude at this time due to significant heterogeneity among studies. We suggest that, instead of not using APs in fear of MI risk, careful cardiovascular monitoring before and during AP treatment in high-risk patients is needed. Additional high-quality prospective studies are required to evaluate the association between APs and the risk of MI.
抗精神病药物（AP）的使用与心肌梗死（MI）风险之间的关联一直不一致，存在争议。因此，我们进行了一项观察性研究的荟萃分析，以解决这一知识空白。
详细进行电子数据库检索，以确定评估 AP 使用与 MI 风险之间关联的观察性研究报告。使用随机或固定效应模型计算汇总优势比（OR）。
共纳入四项病例对照研究、两项病例交叉研究、一项病例-病例时间对照研究、三项队列研究和一项自身对照病例系列研究。与非使用者相比，任何 AP 使用与 MI 风险之间的汇总 OR（95%置信区间（CI））为 1.55（1.33-1.79）：非典型 AP 使用为 1.39（1.06-1.82），典型 AP 使用为 1.57（1.29-1.91）。亚组分析表明，男性性别、精神分裂症诊断和 AP 暴露期≤60 天与 MI 风险增加相关。
基于 10 项观察性研究的现有证据表明，AP 使用可能是 MI 的潜在危险因素。然而，由于研究之间存在显著异质性，目前我们无法得出结论。我们建议，在高风险患者中，在开始 AP 治疗之前和期间，不应因担心 MI 风险而不使用 AP，而是需要进行仔细的心血管监测。需要开展更多高质量的前瞻性研究来评估 AP 与 MI 风险之间的关联。
