Methadone and the QTc Interval: Paucity of Clinically Significant Factors in a Retrospective Cohort.
Methadone and the QTc Interval: Paucity of Clinically Significant Factors in a Retrospective Cohort.
复制标题
DOI：
10.1097/adm.0000000000000353
复制
发表时间：
2017
影响因子：
5.5
通讯作者：
Bart BA
中科院分区：
文献类型：
--
作者：
Bart G;Wyman Z;Wang Q;Hodges JS;Karim R;Bart BA
美沙酮与心电图QTc间期延长有关。QTc间期延长可能与心律失常和心源性猝死有关。这些事件在美沙酮维持患者中的发生率未知。这项回顾性队列研究纳入了749例通过单一安全网医院接受美沙酮维持治疗的阿片类药物使用障碍患者，查询了电子健康记录的心电图结果、人口统计学、美沙酮剂量和与心脏传导障碍（ICD-9 426）和心律失常（ICD-9 427）一致的诊断代码。探讨与QTc间期相关的因素;使用Cox比例风险回归模型分析至可能导致心源性猝死事件的时间。134例患者在服用美沙酮时进行了心电图检查，404例患者在停用美沙酮时进行了心电图检查，211例患者在服用和停用美沙酮时都进行了心电图检查。接受美沙酮治疗时的平均QTc间期（436 msec，SD 36）显著大于停药时（423 msec，SD 33）。年龄和美沙酮剂量与QTc间期延长弱相关（分别为p<0.01和p<0.0005，校正R2=0.05）。在7，064患者年（6.3起事件/1，000患者年）中，有44起ICD-9 426和427起事件。QTc大于性别特异性截止值与至事件发生时间显著相关（风险比3.32; 95% CI 1.25-8.81），但接受美沙酮治疗与此无关。美沙酮与QTc间期延长呈非临床显著剂量相关性。心脏事件罕见，心源性猝死率低于一般人群。应重新考虑目前对美沙酮维持患者进行心脏风险评估的建议。
Methadone is associated with prolongation of the electrocardiographic QTc interval. QTc prolongation may be linked to cardiac dysrhythmia and sudden cardiac death. The rate of these events is unknown in methadone-maintained patients. This retrospective cohort study of 749 patients with opioid use disorder receiving methadone maintenance therapy through a single safety-net hospital, queried the electronic health record for electrocardiogram results, demographics, methadone dose, and diagnostic codes consistent with cardiac conduction disorder (ICD-9 426) and cardiac dysrhythmia (ICD-9 427). Factors associated with QTc interval were explored; Cox-proportional hazards regression models were used to analyze time to an event that may predispose to sudden cardiac death. One hundred thirty four patients had an electrocardiogram while on methadone, 404 while off methadone, and 211 both while on and off methadone. Mean QTc interval while on methadone (436 msec, SD 36) was significantly greater than while off (423 msec, SD 33). Age and methadone dose were weakly associated with increased QTc interval (p<0.01 and p<0.0005, respectively, adjusted R2=0.05). There were 44 ICD-9 426 and 427 events over 7,064 patient years (6.3 events/1,000 patient years). Having a QTc greater than gender specific cut-off values was significantly associated with time to event (hazard ratio 3.32; 95% CI 1.25-8.81) but being on methadone was not. Methadone is associated with QTc prolongation in a non-clinically significant dose-related manner. Cardiac events were rare and the sudden cardiac death rate was below that of the general population. Current recommendations for cardiac risk assessment in methadone maintained patients should be reconsidered.