Author + information
- Received April 6, 2020
- Accepted June 2, 2020
- Published online July 27, 2020.
- Dong Oh Kang, MDa,∗,
- Hyonggin An, PhDb,∗,
- Geun U Park, MSc,
- Yunjin Yum, MSb,
- Eun Jin Park, MDa,
- Yoonjee Park, MDa,
- Won Young Jang, MDd,
- Woohyeun Kim, MDa,
- Jah Yeon Choi, MDa,
- Seung-Young Roh, MDa,
- Jin Oh Na, MD, PhDa,
- Jin Won Kim, MD, PhDa,
- Eung Ju Kim, MD, PhDa,
- Seung-Woon Rha, MD, PhDa,
- Chang Gyu Park, MD, PhDa,
- Hong Seog Seo, MD, PhDa and
- Cheol Ung Choi, MD, PhDa,∗ ()
- aCardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- bDepartment of Biostatistics, Korea University College of Medicine, Seoul, Korea
- cLINEWALKS, Seoul, Korea
- dDivision of Cardiology, Department of Internal Medicine, Catholic University of Korea St. Vincent’s Hospital, Suwon, Korea
- ↵∗Address for correspondence:
Dr. Cheol Ung Choi, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea.
Background Limited data are available regarding the risk for adverse clinical events with concomitant nonsteroidal anti-inflammatory drug (NSAID) treatment after myocardial infarction (MI).
Objectives The aim of this study was to investigate the risk for cardiovascular and bleeding events according to groups of antithrombotic medications and subtypes of NSAIDs in patients with MI.
Methods This was a nationwide cohort study to enroll a study population from the Health Insurance Review and Assessment Service database in Korea between 2009 and 2013. Patients were divided into groups on the basis of the prescribed antithrombotic medications. The primary and secondary outcomes were thromboembolic cardiovascular and clinically relevant bleeding events. The risk for adverse clinical events was assessed by ongoing NSAID treatment and subtypes of NSAIDs.
Results In total, 108,232 patients (mean age 64.2 ± 12.8 years, 72.1% men, mean follow-up duration 2.3 ± 1.8 years) with first diagnosed MI were enrolled. Concomitant NSAID treatment significantly increased the risk for cardiovascular events (hazard ratio [HR]: 6.96; 95% confidence interval [CI]: 6.24 to 6.77; p < 0.001) and bleeding events (HR: 4.08; 95% CI: 3.51 to 4.73; p < 0.001) compared with no NSAID treatment. Among NSAID subtypes, the risk for cardiovascular and bleeding events was lowest with the use of celecoxib (HR: 4.65; 95% CI: 3.17 to 6.82; p < 0.001, and 3.44; 95% CI: 2.20 to 5.39; p < 0.001, respectively) and meloxicam (HR: 3.03; 95% CI: 1.68 to 5.47; p < 0.001, and 2.80; 95% CI: 1.40 to 5.60; p < 0.001, respectively).
Conclusions Concomitant NSAID treatment significantly increased the risk for cardiovascular and bleeding events after MI. Although NSAID treatment should be avoided after MI, celecoxib and meloxicam could be considered as alternative options in cases in which NSAID use is unavoidable.
- antithrombotic therapy
- myocardial infarction
- nonsteroidal anti-inflammatory drugs
↵∗ Drs. Kang and An contributed equally to this work.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received April 6, 2020.
- Accepted June 2, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.