Gum P A, Thamilarasan M, Watanabe J, Blackstone E H, Lauer M S
Department of Cardiology, Desk F25, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA.
JAMA. 2001 Sep 12;286(10):1187-94. doi: 10.1001/jama.286.10.1187.
Although aspirin has been shown to reduce cardiovascular morbidity and short-term mortality following acute myocardial infarction, the association between its use and long-term all-cause mortality has not been well defined.
To determine whether aspirin is associated with a mortality benefit in stable patients with known or suspected coronary disease and to identify patient characteristics that predict the maximum absolute mortality benefit from aspirin.
Prospective, nonrandomized, observational cohort study conducted between 1990 and 1998 at an academic medical institution, with a median follow-up of 3.1 years.
Of 6174 consecutive adults undergoing stress echocardiography for evaluation of known or suspected coronary disease, 2310 (37%) were taking aspirin. Patients with significant valvular disease or documented contraindication to aspirin use, including peptic ulcer disease, renal insufficiency, and use of nonsteroidal anti-inflammatory drugs, were excluded.
All-cause mortality according to aspirin use.
During 3.1 years of follow-up, 276 patients (4.5%) died. In a simple univariable analysis, there was no association between aspirin use and mortality (4.5% vs 4.5%). However, after adjustment for age, sex, standard cardiovascular risk factors, use of other medications, coronary disease history, ejection fraction, exercise capacity, heart rate recovery, and echocardiographic ischemia, aspirin use was associated with reduced mortality (hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.51-0.87; P =.002). In further analysis using matching by propensity score, 1351 patients who were taking aspirin were at lower risk for death than 1351 patients not using aspirin (4% vs 8%, respectively; HR, 0.53; 95% CI, 0.38-0.74; P =.002). After adjusting for the propensity for using aspirin, as well as other possible confounders and interactions, aspirin use remained associated with a lower risk for death (adjusted HR, 0.56; 95% CI, 0.40-0.78; P<.001). The patient characteristics associated with the most aspirin-related reductions in mortality were older age, known coronary artery disease, and impaired exercise capacity.
Aspirin use among patients undergoing stress echocardiography was independently associated with reduced long-term all-cause mortality, particularly among older patients, those with known coronary artery disease, and those with impaired exercise capacity.
尽管阿司匹林已被证明可降低急性心肌梗死后的心血管发病率和短期死亡率，但其使用与长期全因死亡率之间的关联尚未明确界定。
确定阿司匹林对已知或疑似冠心病的稳定患者是否具有死亡率获益，并识别能预测阿司匹林最大绝对死亡率获益的患者特征。
1990年至1998年在一所学术性医疗机构进行的前瞻性、非随机、观察性队列研究，中位随访时间为3.1年。
在6174名连续接受负荷超声心动图检查以评估已知或疑似冠心病的成年人中，2310名（37%）正在服用阿司匹林。排除患有严重瓣膜病或有阿司匹林使用禁忌证记录的患者，包括消化性溃疡病、肾功能不全以及使用非甾体抗炎药的患者。
根据阿司匹林使用情况的全因死亡率。
在3.1年的随访期间，276名患者（4.5%）死亡。在简单的单变量分析中，阿司匹林使用与死亡率之间无关联（4.5%对4.5%）。然而，在对年龄、性别、标准心血管危险因素、其他药物使用、冠心病病史、射血分数、运动能力、心率恢复以及超声心动图缺血情况进行调整后，阿司匹林使用与死亡率降低相关（风险比[HR]，0.67；95%置信区间[CI]，0.51 - 0.87；P = 0.）。在使用倾向评分匹配的进一步分析中，1351名服用阿司匹林的患者死亡风险低于1351名未使用阿司匹林的患者（分别为4%对8%；HR，0.53；95%CI，0.38 - 0.74；P = 0.）。在对使用阿司匹林倾向以及其他可能的混杂因素和相互作用进行调整后，阿司匹林使用仍与较低的死亡风险相关（调整后HR，0.56；95%CI，0.40 - 0.78；P < 0.）。与阿司匹林相关的死亡率降低最多相关的患者特征为年龄较大、已知冠状动脉疾病以及运动能力受损。
接受负荷超声心动图检查的患者使用阿司匹林与长期全因死亡率降低独立相关，尤其是在老年患者、已知冠状动脉疾病患者以及运动能力受损的患者中。
