Equipe d’acceuil ‘Pharmacoépidémiologie et Maladies ’Infectieuses’, Institut Pasteur, Paris, France.
Heart. 2011 Nov;97(22):1834-40. doi: 10.1136/hrt.2011.222448. Epub 2011 Aug 31.
The objective of this study was to explore the association of non-steroidal anti-inflammatory drugs (NSAID) with ST-segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI).
DESIGN, SETTING & PATIENTS: A matched case-control study comparing patients with incident non-fatal myocardial infarction (MI) collected by cardiologists with controls. Cases were retrieved from the Pharmacoepidemiological General Research on Myocardial Infarction (PGRx-MI) registry, a French nationwide registry consisting of 55 cardiology centres, whereas controls were selected from general practice settings. Both cases and controls were recruited from the same geographically diverse areas across continental France.
The association between NSAID and MI was assessed by matched adjusted OR from conditional logistic regression.
Between 2007 and 2009, 1125 incident cases were included (67.3% and 32.7% for STEMI and NSTEMI, respectively), with 2790 controls matched to MI cases by age and sex. Current use (previous 2 months) of either diclofenac or naproxen and other arylpropionic acid NSAID was not associated with STEMI (OR 0.9, 95% CI 0.4 to 1.9 and OR 1.0, 95% CI 0.6 to 1.7, respectively), instead it showed significant association with NSTEMI (OR 2.8, 95% CI 1.2 to 6.4 and OR 0.4, 95% CI 0.2 to 0.9, respectively). Our study confirms results from previously published analyses on the association of MI with NSAID (OR 1.5, 0.9, and 1.0 for diclofenac, naproxen and related NSAID, and all NSAID combined, respectively).
Our study shows that the MI risk modification associated with NSAID is limited to NSTEMI.
本研究旨在探讨非甾体抗炎药（NSAID）与 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死（NSTEMI）的相关性。
设计、设置和患者：本研究采用病例对照研究设计，比较了由心脏病专家收集的新发非致命性心肌梗死（MI）患者与对照者。病例来自法国全国性登记处 Pharmacoepidemiological General Research on Myocardial Infarction（PGRx-MI）登记处，该登记处由 55 个心脏病中心组成，而对照者则从普通实践环境中选择。病例和对照者均来自法国各地的地理区域。
通过条件逻辑回归的匹配调整比值比（OR）评估 NSAID 与 MI 之间的相关性。
在 2007 年至 2009 年期间，共纳入 1125 例新发病例（STEMI 分别为 67.3%和 32.7%，NSTEMI 分别为 67.3%和 32.7%），并与 MI 病例按年龄和性别匹配了 2790 例对照者。当前（过去 2 个月）使用双氯芬酸或萘普生和其他芳基丙酸类 NSAID 与 STEMI 无关（OR 0.9，95%CI 0.4 至 1.9 和 OR 1.0，95%CI 0.6 至 1.7），但与 NSTEMI 显著相关（OR 2.8，95%CI 1.2 至 6.4 和 OR 0.4，95%CI 0.2 至 0.9）。我们的研究证实了先前发表的关于 NSAID 与 MI 相关性的分析结果（OR 1.5，0.9，和 1.0 分别为双氯芬酸、萘普生和相关 NSAID，以及所有 NSAID 联合）。
我们的研究表明，与 NSAID 相关的 MI 风险改变仅限于 NSTEMI。
