Lassen Thomas Ravn, Szentkúti Péter, Sørensen Henrik Toft, Bøtker Hans Erik, Sundbøll Jens
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Pharmacoepidemiol Drug Saf. 2025 Apr;34(4):e70141. doi: 10.1002/pds.70141.
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.
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.
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]).
Paroxetine was not associated with clinically significant improvement in post-MI outcomes compared with non-paroxetine SSRI drugs.
动物研究表明，与其他选择性5-羟色胺再摄取抑制剂（SSRI）不同，帕罗西汀可能减轻心肌梗死（MI）后心力衰竭。我们在临床环境中研究帕罗西汀与非帕罗西汀类SSRI对MI后死亡率和心力衰竭风险的有效性。
我们基于丹麦医疗登记系统进行了一项全国性的基于人群的队列研究。采用活性对照设计，我们比较了帕罗西汀与非帕罗西汀类SSRI药物对MI后结局的有效性。这包括1995年至2020年期间在丹麦因MI住院、入院前90天内兑换过SSRI处方且在180天随访期后测量结局变量的所有患者。我们计算累积发病率作为风险指标，并使用Cox回归计算所有结局的风险比（HR），对性别、年龄组、个体合并症和合并用药进行调整。
我们确定了13053例在MI入院时接受SSRI治疗的患者。帕罗西汀类SSRI使用者的全因死亡率（24.7%对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]））的累积发病率低于非帕罗西汀类SSRI使用者，但心力衰竭方面（11.0%对11.8%（-0.7%[95%CI：-3.13；1.65]））并非如此。调整后的风险比（aHR）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]）方面无显著差异。
与非帕罗西汀类SSRI药物相比，帕罗西汀在MI后结局方面未显示出具有临床意义的改善。
