Author + information
- Received June 26, 1997
- Revision received October 3, 1997
- Accepted October 23, 1997
- Published online February 1, 1998.
- Ayman S Al-Khadra, MDA,
- Deeb N Salem, MD, FACCA,
- William M Rand, PhDA,
- James E Udelson, MD, FACCA,
- John J Smith, MD, PhD, FACCA and
- Marvin A Konstam, MD, FACCA,* ()
- ↵*Dr. Marvin A. Konstam, Box 108, Division of Cardiology, New England Medical Center Hospitals, 750 Washington Street, Boston, Massachusetts 02111.
Objectives. This study sought to evaluate the relation between antiplatelet agent (APA) use and survival and morbidity from cardiac disease in patients with left ventricular (LV) systolic dysfunction.
Background. APAs play an important role in the prevention and treatment of coronary disease. Their effects in patients with LV systolic dysfunction are unknown.
Methods. We reviewed data on APA use in 6,797 patients enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) trial and analyzed the relation between their use and all-cause mortality as well as the combined end point of death or hospital admission for heart failure (HF). We used Cox regression to adjust for differences in baseline characteristics and to test for the interaction between APA use and selected patient variables in relation to outcome.
Results. APA use (46.3% of patients) was associated with significantly reduced mortality from all causes (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.73 to 0.92, p = 0.0005) and reduced risk of death or hospital admission for HF (adjusted HR 0.81, 95% CI 0.74 to 0.89, p < 0.0001) but was not influenced by trial assignment, gender, LV ejection fraction, New York Heart Association class or etiology. A strong interaction was observed among APA use, randomization group and all-cause mortality. The association between APA use and survival was not observed in the enalapril group, nor was an enalapril benefit on survival detectable in patients receiving APAs at baseline. However, randomization to enalapril therapy significantly reduced the combined end point of death or hospital admission for HF in APA users.
Conclusions. In patients with LV systolic dysfunction, use of APAs is associated with improved survival and reduced morbidity. This association is retained after adjustment for baseline characteristics. APA use is associated with retained but reduced benefit from enalapril.
☆ Support for this study was provided through the General Clinical Research Center, funded by the Division of Research Resources of the National Institutes of Health, Bethesda, Maryland under Grant MO1-RR00054. The Studies of Left Ventricular Dysfunction (SOLVD) trial was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, with a contribution from Merck Sharpe and Dohme Pharmaceutical Company, West Point, Pennsylvania.
This work was presented in part at the 68th Annual Scientific Sessions of the American Heart Association, Anaheim, California, November 1995.
- Received June 26, 1997.
- Revision received October 3, 1997.
- Accepted October 23, 1997.
- The American College of Cardiology