Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Am J Med. 2017 Apr;130(4):462-468. doi: 10.1016/j.amjmed.2016.10.023. Epub 2016 Nov 23.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in perioperative pain management of patients undergoing coronary artery bypass graft surgery. However, the association of periprocedural use of NSAIDs and clinical outcomes after coronary artery bypass graft is understudied.
We conducted a retrospective analysis using pooled data from 2 multicenter randomized controlled trials (PREVENT IV [n = 3014] and MEND-CABG II [n = 3023]). Rates of death, death or myocardial infarction, and death, myocardial infarction, or stroke in the 30 days following coronary artery bypass graft surgery were compared in patients using or not using perioperative NSAIDs. Inverse probability of treatment weighting and Cox proportional hazards regression models were used to adjust for confounding.
A total of 5887 patients were studied. Median age was 65 years, 78% were male, and 91% were White. NSAIDs were used in 2368 (40.2%) patients. The majority of patients (1822 [30.9%]) received NSAIDs after coronary artery bypass graft surgery; 289 (4.9%) used them prior to and after the surgery; and 257 (4.4) received NSAIDs prior to the surgery only. Adjusted 30-day outcomes were similar in patients receiving and not receiving NSAIDs (death: hazard ratio [HR] 1.18; 95% confidence interval [CI], 0.48-2.92; death or myocardial infarction: HR 0.87; 95% CI, 0.42-1.79; death, myocardial infarction, or stroke: HR 0.87; 95% CI, 0.46-1.65).
In this pooled data analysis, perioperative NSAID use was common among patients undergoing coronary artery bypass graft surgery and was not associated with an increased short-term risk for major adverse clinical outcomes.
非甾体抗炎药（NSAIDs）常用于接受冠状动脉旁路移植术的围手术期疼痛管理。然而，围手术期使用 NSAIDs 与冠状动脉旁路移植术后临床结局的关联尚未得到充分研究。
我们使用来自 2 项多中心随机对照试验（PREVENT IV [n=3014]和 MEND-CABG II [n=3023]）的汇总数据进行了回顾性分析。比较了围手术期使用和不使用 NSAIDs 的患者在冠状动脉旁路移植术后 30 天内的死亡率、死亡或心肌梗死率以及死亡、心肌梗死或卒中型。使用逆概率治疗加权和 Cox 比例风险回归模型调整混杂因素。
共纳入 5887 例患者。中位年龄为 65 岁，78%为男性，91%为白人。2368 例（40.2%）患者使用了 NSAIDs。大多数患者（1822 例 [30.9%]）在冠状动脉旁路移植术后使用 NSAIDs；289 例（4.9%）在手术前后使用；257 例（4.4%）仅在手术前使用 NSAIDs。接受和不接受 NSAIDs 的患者调整后的 30 天结局相似（死亡：风险比 [HR] 1.18；95%置信区间 [CI]，0.48-2.92；死亡或心肌梗死：HR 0.87；95% CI，0.42-1.79；死亡、心肌梗死或卒中型：HR 0.87；95% CI，0.46-1.65）。
在这项汇总数据分析中，接受冠状动脉旁路移植术的患者围手术期使用 NSAIDs 很常见，与短期主要不良临床结局风险增加无关。
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