Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain.
PLoS One. 2011 Feb 8;6(2):e16780. doi: 10.1371/journal.pone.0016780.
Recent clinical trials and observational studies have reported increased coronary events associated with non steroidal anti-inflammatory drugs (NSAIDs). There appeared to be a disproportionate increase in non-fatal versus fatal events, however, numbers of fatal events in individual studies were too small, and event rates too low, to be meaningful.
We undertook a pooled analysis to investigate the effect of NSAIDs on myocardial infarction (MI) risk with the specific aim to differentiate non-fatal from fatal events.
We searched Pubmed (January, 1990 to March, 2010) for observational studies and randomised controlled trials that assessed the effect of NSAIDs (traditional or selective COX-2 inhibitors [coxibs]) on MI incidence separately for fatal and non-fatal events. Summary estimates of relative risk (RR) for non-fatal and fatal MIs were calculated with a random effects model.
NSAID therapy carried a RR of 1.30 (95% CI, 1.20-1.41) for non-fatal MI with no effect on fatal MI (RR 1.02, 95% CI, 0.89-1.17) in six observational studies. Overall, the risk increase for non-fatal MI was 25% higher (95% CI, 11%-42%) than for fatal MI. The two studies that included only individuals with prior cardiovascular disease presented risk estimates for non-fatal MI on average 58% greater (95% CI, 26%-98%) than those for fatal MI. In nine randomised controlled trials, all investigating coxibs, the pooled RR estimate for non-fatal MI was 1.61 (95% CI, 1.04-2.50) and 0.86 (95% CI 0.51-1.47) for fatal MIs.
NSAID use increases the risk of non-fatal MI with no substantial effect on fatal events. Such differential effects, with potentially distinct underlying pathology may provide insights into NSAID-induced coronary pathology. We studied the association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of myocardial infarction (MI), separating non-fatal from fatal events, summarizing the evidence from both observational studies and randomised controlled trials. An increased risk of non-fatal MI was clearly found in both types of studies while use of NSAID did not confer an increased risk of fatal MI. Our findings provide support for the concept that thrombi generated under NSAID treatment could be different from spontaneous thrombi.
最近的临床试验和观察性研究报告称，非甾体抗炎药（NSAIDs）与冠状动脉事件增加有关。然而，非致命性事件与致命性事件相比似乎呈不成比例的增加，但是，个别研究中的致命性事件数量太少，事件发生率太低，因此没有意义。
我们进行了一项荟萃分析，以研究 NSAIDs 对心肌梗死（MI）风险的影响，具体目的是区分非致命性和致命性事件。
我们在 Pubmed 上进行了检索（1990 年 1 月至 2010 年 3 月），以评估 NSAIDs（传统或选择性 COX-2 抑制剂[COXIBs]）对致命和非致命性事件的 MI 发生率的影响。使用随机效应模型计算非致命性和致命性 MI 的相对风险（RR）的汇总估计值。
在六项观察性研究中，NSAID 治疗与非致命性 MI 的 RR 为 1.30（95%CI，1.20-1.41），而对致命性 MI 没有影响（RR 1.02，95%CI，0.89-1.17）。总的来说，非致命性 MI 的风险增加了 25%（95%CI，11%-42%），而致命性 MI 的风险增加了 58%（95%CI，26%-98%）。在两项仅纳入有既往心血管疾病史的个体的研究中，非致命性 MI 的风险估计值平均比致命性 MI 高 58%（95%CI，26%-98%）。在九项随机对照试验中，均研究 COXIBs，非致命性 MI 的汇总 RR 估计值为 1.61（95%CI，1.04-2.50），致命性 MI 的 RR 估计值为 0.86（95%CI，0.51-1.47）。
NSAID 的使用增加了非致命性 MI 的风险，而对致命性事件没有实质性影响。这些不同的影响，可能具有不同的潜在病理机制，可能为 NSAID 诱导的冠状动脉病理提供见解。我们研究了非甾体抗炎药（NSAIDs）的使用与心肌梗死（MI）风险之间的关联，将非致命性与致命性事件分开，综合了观察性研究和随机对照试验的证据。在这两种类型的研究中，均明确发现非致命性 MI 的风险增加，而 NSAID 的使用并未增加致命性 MI 的风险。我们的研究结果为血栓形成理论提供了支持，即 NSAID 治疗下产生的血栓可能与自发性血栓不同。
