Abstract 12945: No Evidence of Cardiovascular Harm of Nonsteroidal Anti-Inflammatory Use During Coronary Artery Bypass: Post-hoc Results From Two Large Multicenter Randomized Trials
Background: COX-2 inhibitor use for CABG postoperative pain has been linked to adverse cardiovascular outcomes. An FDA black box warning on the use of all NSAIDs peri-CABG subsequently ensued, largely based on a single well-controlled study of COX-2 inhibition. Given the significant opioid toxicity profile and poor efficacy of acetaminophen in this setting, further exploration of all NSAID use peri-CABG is warranted.
Methods: We conducted a post-hoc analysis of two large international, multicenter, prospectively-designed, pivotal CABG investigations (PREVENT-IV-Project of Ex-vivo Vein Graft Engineering via Transfection and MEND-CABG-II-MC-1 to Eliminate Necrosis and Damage in Coronary Artery Bypass Graft Surgery Trial), comparing 30-day cardiovascular complications following discharge in patients who did and did not receive NSAIDs perioperatively. Potential confounding was addressed through inverse probability weighting using propensity scores.
Results: We studied 4901 patients (median age 65; male 78%; caucasian 90%). Co-morbidities included diabetes 42%, current smoker 25%, hypercholesterolemia 80%, hypertension 78%, previous stroke 6%, previous PCI 28%, previous MI 48%, AF 6%, CHF 14% and PVD 10%. A total of 1930 (39%) patients did and 2971 (61%) patients did not receive NSAIDs. After inverse weighting with propensity scores, no baseline differences were observed between groups. Cardiovascular event rates and adjusted odds ratios with 95% confidence intervals follow for NSAID vs. no-NSAID patients: death 0.7% vs. 1.1% (OR 0.8, CI 0.4-1.5), post-operative MI 1.0% vs. 0.9% (OR 0.9, CI 0.5-1.6), death or post-operative MI 1.2% vs. 1.3% (OR 0.9, CI 0.6-1.6), stroke 1.2% vs. 1.6% (OR 0.9, CI 0.6-1.5), and revascularization 8.0% vs. 8.7% (OR 0.99, CI 0.8-1.2).
Conclusion: Although event rates are low, NSAID use was not associated with an increased cardiovascular risk, corroborating earlier findings at our single center. Postoperative management of CABG pain with NSAIDs requires further investigation before this class of medications is fully abandoned in peri-operative settings.
- © 2011 by American Heart Association, Inc.