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.

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.