title: Ongoing treatment with non-steroidal anti-inflammatory drugs at time of admission is associated with poorer prognosis in patients with first-time acute myocardial infarction.
abstract: BACKGROUND
  Use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with increased cardiovascular morbidity and mortality. The purpose of this study was to examine the effect of ongoing NSAID treatment at time of admission for myocardial infarction (MI) on prognosis.
  
  
  METHODS
  All patients admitted with first-time MI in 1997-2006 were included by use of individual-level linkage of nationwide registries. By claimed prescription of NSAIDs, availability of tablets was estimated within 14 days prior to inclusion and defined ongoing use. Risk of death within 30 days and risk of death or MI within 1 year was analyzed by logistic regression and Cox proportional-hazard models, respectively.
  
  
  RESULTS
  A total of 97,458 patients were included (mean age 69.9 [SD 13.2] years and 62% males); the 30 day and 1 year mortality rates were 18.1% and 27.7%, respectively. Ongoing NSAID treatment was identified in 12,156 (12.5%) patients and 30-day mortality was significantly increased in patients receiving rofecoxib (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.22-1.68) and celecoxib (OR 1.23; CI 1.03-1.47) relative to no use of NSAIDs. Correspondingly, the 1-year rate of death or recurrent MI was significantly increased in patients receiving rofecoxib (hazard ratio [HR] 1.15; CI 1.04-1.27), celecoxib (HR 1.13; CI 1.01-1.26), diclofenac (HR 1.12; CI 1.04-1.20) or any NSAID use (HR 1.05; CI 1.02-1.09). No association was found for naproxen or ibuprofen.
  
  
  CONCLUSIONS
  Ongoing treatment with NSAIDs and in particular the cyclooxygenase-2-selective inhibitors rofecoxib, celecoxib, and diclofenac is associated with worsened prognosis in patients admitted with first-time MI.
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. Electronic address: mortenlamberts@gmail.com.
authors.forename: Morten
authors.initials: M
authors.lastname: Lamberts
authors.forename: Emil L
authors.initials: EL
authors.lastname: Fosbøl
authors.forename: Anne-Marie S
authors.initials: AM
authors.lastname: Olsen
authors.forename: Morten L
authors.initials: ML
authors.lastname: Hansen
authors.forename: Frederik
authors.initials: F
authors.lastname: Folke
authors.forename: Søren L
authors.initials: SL
authors.lastname: Kristensen
authors.forename: Jonas B
authors.initials: JB
authors.lastname: Olesen
authors.forename: Peter R
authors.initials: PR
authors.lastname: Hansen
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Gunnar H
authors.initials: GH
authors.lastname: Gislason
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D010343:Patient Admission / Q000639:trends*; D011379:Prognosis; D012042:Registries; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Acute myocardial infarction; NSAID; Non-steroidal anti-inflammatory drug; Pharmocoepidemiology; Prognosis