Department of Emergency Medicine and the Cardiovascular Research Institute, Wayne State University School of Medicine, 4201 St Antoine, Detroit, MI 48201, USA.
Am Heart J. 2010 Feb;159(2):222-230.e2. doi: 10.1016/j.ahj.2009.11.009.
Conflicting data exist regarding a potential deleterious association between aspirin (ASA) and angiotensin-converting enzyme inhibitors (ACEIs) when used concurrently in patients with heart failure (HF). How such an interaction may be influenced by underlying etiology of HF and whether it extends to patients treated with angiotensin receptor blockers (ARBs), however, are not known.
Eligible patients from the OPTIMIZE-HF registry were dichotomized into those with ischemic or nonischemic HF. Potential associations between ASA and ACEI or ARB use and 60- to 90-day postdischarge outcomes were assessed using Cox proportional and logistic regression modeling. Models were adjusted for factors known to influence the outcome of interest and by propensity score for ACEI or ARB prescription after an index HF admission.
Mortality was not increased (hazard ratio [95% CI]) when ASA was used in conjunction with ACEI (0.51 [0.29-0.87]) or ARB (0.29 [0.09-0.96]) in patients with ischemic or nonischemic (ACEI 0.71 [0.42-1.21], ARB 1.42 [0.74-2.74]) HF. Regression model parameter estimates trended toward harm reduction, but interaction terms for mortality and a composite of mortality or rehospitalization were nonsignificant (P for all >.05).
When combined with ACEI or ARB, ASA had no demonstrable adverse effect on intermediate-term postdischarge outcomes for patients with ischemic or nonischemic HF.
在心力衰竭（HF）患者中同时使用阿司匹林（ASA）和血管紧张素转换酶抑制剂（ACEI）时，存在相互矛盾的数据表明其可能存在有害的关联。但是，尚不清楚这种相互作用可能会受到 HF 潜在病因的影响，以及它是否会扩展到接受血管紧张素受体阻滞剂（ARB）治疗的患者。
从 OPTIMIZE-HF 注册中心中选择符合条件的患者，并将其分为缺血性或非缺血性 HF 患者。使用 Cox 比例风险和逻辑回归模型评估 ASA 与 ACEI 或 ARB 使用之间与 60-90 天出院后结局的潜在关联。调整了已知影响感兴趣结局的因素，并通过 ACEI 或 ARB 处方的倾向评分进行了调整。
在缺血性或非缺血性 HF 患者中，ASA 与 ACEI（0.51 [0.29-0.87]）或 ARB（0.29 [0.09-0.96]）联合使用时，死亡率并未增加（风险比[95%CI]）。ACEI（0.71 [0.42-1.21]）或 ARB（1.42 [0.74-2.74]）HF 患者中。回归模型参数估计值趋于降低风险，但死亡率和死亡率或再入院的复合事件的交互项无统计学意义（所有 P 值>.05）。
当与 ACEI 或 ARB 联合使用时，ASA 对缺血性或非缺血性 HF 患者的出院后中期结局无明显不良影响。
