阿司匹林的使用是否会对接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗的住院患者的中期出院后结局产生不利影响？来自心力衰竭患者院内救生治疗便利化组织计划（OPTIMIZE-HF）的研究结果。

Does aspirin use adversely influence intermediate-term postdischarge outcomes for hospitalized patients who are treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers? Findings from Organized Program to Facilitate Life-Saving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF).

机构信息

Department of Emergency Medicine and the Cardiovascular Research Institute, Wayne State University School of Medicine, 4201 St Antoine, Detroit, MI 48201, USA.

出版信息

Am Heart J. 2010 Feb;159(2):222-230.e2. doi: 10.1016/j.ahj.2009.11.009.

DOI:10.1016/j.ahj.2009.11.009

PMID:20152220

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

When combined with ACEI or ARB, ASA had no demonstrable adverse effect on intermediate-term postdischarge outcomes for patients with ischemic or nonischemic HF.

摘要

背景

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。

方法

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。

结果

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）。