Abstract 996: Ongoing NSAID Treatment at Time of Admission for First-time Acute Myocardial Infarction is Associated With Adverse Prognosis
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with increased cardiovascular morbidity and mortality, especially in patients with established cardiovascular disease.
Objectives: To examine the prognostic importance of ongoing NSAID treatment at time of admission for acute myocardial infarction (MI).
Methods: All patients admitted with first-time MI with or without ongoing NSAID treatment were identified from nationwide registries of hospitalizations and drug dispensing from pharmacies in Denmark 1997–2006. Mortality after 30 days and 1 year was analyzed by multivariable Cox proportional-hazard models adjusted for age, gender, calendar year, concomitant pharmacotherapy, and comorbidity.
Results: A total of 97,458 patients were included (mean age 69.9 [SD 13.2] years, 62% males) and the 30 day and 1 year mortality was 18.1% and 27.6%, respectively. Ongoing NSAID treatment at time of MI admission was identified in 12,156 (12.5%) patients. The multivariable adjusted Cox regression analysis demonstrated increased 30 day mortality in patients receiving rofecoxib (hazard ratio [HR] 1.18; 95% confidence interval [CI] 1.04 –1.35) and diclofenac (HR 1.13; CI 1.05–1.21), and increased 1 year mortality in patients receiving rofecoxib (HR 1.17; CI 1.06 –1.30), celecoxib (HR 1.12; CI 1.00 –1.25) and diclofenac (HR 1.13; CI 1.05–1.20) compared with patients not receiving NSAID at admission.
Conclusion: Ongoing treatment with rofecoxib, celecoxib, and diclofenac is associated with adverse prognosis in patients admitted with first-time MI. The results support marked caution with use of NSAIDs in subjects at increased cardiovascular risk.