Selective serotonin reuptake inhibitor use and outcomes in pulmonary arterial hypertension
Selective serotonin reuptake inhibitor use and outcomes in pulmonary arterial hypertension
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DOI：
10.1016/j.pupt.2006.01.001
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发表时间：
2006-01-01
影响因子：
3.2
通讯作者：
Barst, Robyn J.
中科院分区：
文献类型：
--
作者：
Kawut, Steven M.;Horn, Evelyn M.;Barst, Robyn J.
背景：肺动脉高压（PAH）的特征是肺血管阻力升高，导致右心室衰竭。5-羟色胺和Scrotonin转运蛋白在PAH的动物和人体研究中起着重要作用。因此，我们假设，PAH患者治疗高亲和力选择性scrotonin再摄取抑制剂（SSRIs）将有一个降低的死亡风险PAH患者不治疗SSRIs.Methods：我们进行了一项回顾性队列研究，84个连续的成人PAH患者进行了初步评价，从1994年1月至2002年6月在肺动脉高压中心的纽约长老会医院。接受高亲和力SSR 1（K-d < 1 nmol）（帕罗西汀、舍曲林或氟西汀）的患者时间被认为是“暴露的”。患者的时间，而接受三环类，非典型，或没有抗抑郁药被认为是“未暴露”。结果：13的84例（15%）在研究期间使用高亲和力SSRls。5名患者在基线时服用高亲和力SSRIs，8名患者在随访期间开始高亲和力SSRIs。从基线评估到开始高亲和力SSRl的中位时间为125（0-1227）天。使用高亲和力SSRI的中位持续时间为482（110-1624）天，使用高亲和力SSRI的总风险时间为18.1人-年。79例（94%）患者接受华法林治疗; 38例（45%）患者接受持续静脉依前列醇治疗; 12例（14%）患者接受持续皮下曲前列尼尔治疗，23例（27%）患者接受口服波生坦治疗。中位随访时间为764天。在研究期间，24名患者死亡，1名患者接受肺移植。SSRI使用者和非使用者之间在年龄、性别、诊断、血流动力学或急性血管反应性发生率方面没有差异。高亲和力SSR 1使用者的死亡风险较低，但与非使用者相比无统计学显著差异（风险比= 0.53，95% CI 0.07至3.9，p = 0.53）。调整人口统计学，诊断，血流动力学，或其他疗法并没有显着改变这一结果。结论：SSR 1的使用与PAH患者的死亡风险降低50%，这是没有统计学意义的队列。更大的队列研究可能更好地定义这种关系;可能需要在PAH患者中进行一项充分把握度的高亲和力SSRls试验。(c)2006爱思唯尔有限公司保留所有权利。
Background: Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary vascular resistance which leads to right ventricular failure. Serotonin and the scrotonin transporter play an important role in animal and human studies of PAH. We therefore hypothesized that PAH patients treated with high-affinity selective scrotonin reuptake inhibitors (SSRIs) would have a reduced risk of death compared to PAH patients not treated with SSRIs.Methods: We performed a retrospective cohort study of 84 consecutive adult PAH patients who underwent initial evaluation from January 1994 to June 2002 at the Pulmonary Hypertension Center of the New York Presbyterian Hospital. Patient-time while receiving high-affinity SSRls (K-d < 1 nmol) (paroxetine, sertraline, or fluoxetine) was considered "exposed". Patient-time while receiving tricyclic, atypical, or no antidepressants was considered "unexposed".Results: Thirteen of the 84 patients (15%) used high-affinity SSRls during the study period. Five patients were taking high-affinity SSRls at baseline and 8 initiated high-affinity SSRIs during the follow-up period. The median time from baseline evaluation until initiation of high-affinity SSRls was 125 (0-1227) days. The median duration of high-affinity SSRI use was 482 (110-1624) days and the total at-risk time on high-affinity SSRls was 18.1 person-years. Seventy-nine (94%) patients were treated with warfarin; 38 (45%) received continuous intravenous epoprostenol; 12 (14%) received continuous subcutaneous treprostinil, and 23 (27%) were treated with oral bosentan. The median follow-up was 764 days. Twenty-four patients died and one underwent lung transplantation during the study period.There were no differences in age, gender, diagnosis, hemodynamics, or incidence of acute vasoreactivity between SSRI users and nonusers. The risk of death for high-affinity SSR1 users was lower but not statistically significantly different from that of non-users (hazard ratio = 0.53, 95% CI 0.07 to 3.9, p = 0.53). Adjustment for demographics, diagnosis, hemodynamics, or other therapies did not significantly change this result.Conclusions: SSR1 use was associated with a 50% reduction in the risk of death in a cohort of PAH patients which was not statistically significant. Larger cohort studies may better define this relationship; an adequately powered trial of high-affinity SSRls in PAH patients may be warranted. (c) 2006 Elsevier Ltd. All rights reserved.