Mental Health Centre Glostrup, Copenhagen University Hospital, Copenhagen, Denmark.
Psychiatric Research Academy, Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark.
Acta Psychiatr Scand. 2018 Jan;137(1):47-53. doi: 10.1111/acps.12827. Epub 2017 Oct 24.
Using national Danish registers, we estimated rates of clozapine-associated cardiac adverse events. Rates of undiagnosed myocarditis were estimated by exploring causes of death after clozapine initiation.
Through nationwide health registers, we identified all out-patients initiating antipsychotic treatment (January 1, 1996-January 1, 2015). Rates of clozapine-associated myocarditis and pericarditis within 2 months from clozapine initiation and rates of cardiomyopathy within 1-2 years from clozapine initiation were compared to rates for other antipsychotics. Mortality within 2 months from clozapine initiation was extracted.
Three thousand two hundred and sixty-two patients of a total 7932 patients initiated clozapine as out-patients (41.12%). One patient (0.03%) developed myocarditis, and no patients developed pericarditis within 2 months from clozapine initiation. Two (0.06%) and four patients (0.12%) developed cardiomyopathy within 1 and 2 years respectively. Rates were similar for other antipsychotics. Twenty-six patients died within 2 months from clozapine initiation. Pneumonia (23.08%) and stroke (11.54%) were the main causes of death. We estimated the maximum rate of clozapine-associated fatal myocarditis to 0.28%.
Cardiac adverse effects in Danish out-patients initiating clozapine treatment are extremely rare and these rates appear to be comparable to those observed for other antipsychotic drugs.
利用丹麦全国性登记处的数据，我们估算了氯氮平相关心脏不良事件的发生率。通过探索氯氮平起始后死亡的原因，估算了未确诊心肌炎的发生率。
通过全国性健康登记处，我们确定了所有开始抗精神病药物治疗的门诊患者（1996 年 1 月 1 日至 2015 年 1 月 1 日）。氯氮平起始后 2 个月内发生心肌炎和心包炎的发生率以及氯氮平起始后 1-2 年内发生心肌病的发生率与其他抗精神病药物进行了比较。提取了氯氮平起始后 2 个月内的死亡率。
7932 例患者中有 3262 例（41.12%）作为门诊患者开始使用氯氮平。1 例（0.03%）患者发生心肌炎，氯氮平起始后 2 个月内无患者发生心包炎。1 例（0.06%）和 4 例（0.12%）患者分别在 1 年和 2 年内发生心肌病。其他抗精神病药物的发生率相似。26 例患者在氯氮平起始后 2 个月内死亡。肺炎（23.08%）和中风（11.54%）是主要死因。我们估计，氯氮平相关致命性心肌炎的最大发生率为 0.28%。
丹麦门诊患者开始氯氮平治疗时发生心脏不良事件极为罕见，这些发生率似乎与其他抗精神病药物观察到的发生率相当。
