Abstract 3288: Association of Treatment with Non-Steroidal Anti-Inflammatory Agents (NSAIDS) on Study Entry with 30 Day Adverse Outcomes Among ST Elevation MI (STEMI) Patients Treated with a Fibrinolytic Agent. An EXTRACT-TIMI 25 Analysis
Background: Many over-the-counter non-aspirin NSAIDs obstruct access to the binding site of aspirin to platelet cyclooxygenase-1 (COX-1), which potentially interferes with aspirin’s cardioprotective role. We hypothesized that treatment with NSAIDs prior to study enrollment would be associated with an increase in the risk of death or myocardial infarction (MI) in patients treated with fibrinolytic agents for STEMI.
Methods: A total of 20,479 subjects treated with fibrinolytic therapy for STEMI in the EXTRACT-TIMI 25 trial were included in the analysis. The primary efficacy endpoint of death or nonfatal recurrent MI through 30 days was compared for pts treated with NSAIDs within 7 days of enrollment vs those not treated.
Results: NSAID treatment at entry was associated with a higher rate of 30 day re MI and death or non fatal re MI (Figure⇓). In a multivariate model adjusting for randomization group and differences in baseline characteristics by NSAID use (including ASA use, CrCl, age, gender, race, htn, smoking, DM, prior MI, h/o PCI, ant MI, lytic type), NSAID use was associated with a higher odds of 30 day re MI (OR 1.44, 95% CI 1.01–2.07, p=0.047) and a strong trend toward death or non fatal re MI (OR 1.29, 95% CI 1.00–1.66, p=0.051).
Conclusions: Among STEMI pts treated with a fibrinolytic agent, treatment with NSAIDs prior to study enrollment was associated with higher rates 30 day re MI as well as death or non fatal re MI. It could be speculated that these adverse outcomes may be due to inhibition of aspirin’s efficacy as well as nephrotoxicity / fluid electrolyte imbalances / hypertension associated with NSAID use, although these data are hypothesis generating and exploratory.