Laudani Claudio, Occhipinti Giovanni, Greco Antonio, Giacoppo Daniele, Spagnolo Marco, Capodanno Davide
Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", University of Catania, Via S. Sofia 76, 95125 Catania, Italy.
Institut Clinic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Carrer de Villarroel, 170, L'Eixample, 08036 Barcelona, Spain.
Eur Heart J Cardiovasc Pharmacother. 2025 May 2;11(3):218-229. doi: 10.1093/ehjcvp/pvae100.
Multiple anti-inflammatory drugs have been tested for secondary prevention after myocardial infarction (MI), giving mixed results and questioning the efficacy of anti-inflammatory therapy. No head-to-head comparisons between anti-inflammatory drugs have been performed. This study aimed to compare the efficacy and safety of anti-inflammatory drugs for secondary prevention after MI and the relative merits of specific drugs and administration strategies.
Randomized trials of anti-inflammatory therapy for secondary prevention after MI were identified. Primary efficacy and safety endpoints were trial-defined major adverse cardiovascular events (MACEs) and serious adverse events. Secondary endpoints included all-cause death, individual MACE components, serious infection, cancer, and gastrointestinal adverse events. Pairwise meta-analyses were conducted with interaction analyses for drug type and timing of administration, in addition to network meta-analyses. Multiple sensitivity and meta-regression analyses were conducted to explore potential heterogeneity sources. Twenty-eight studies, involving 44 406 patients with a mean follow-up of 11 months, were included. Anti-inflammatory therapy reduced the incidence of MACEs [incidence rate ratio (IRR): 0.92; 95% confidence interval (CI): 0.86-0.98] compared to control, without increasing serious adverse events. However, it was associated with a higher incidence of gastrointestinal adverse events (IRR: 1.21; 95% CI: 1.07-1.36). No significant interaction was observed between the effects of anti-inflammatory therapy on MACE and the timing of administration.
In secondary prevention for MI, anti-inflammatory therapy significantly reduces MACE without increasing serious adverse events, but it is associated with an increased risk of gastrointestinal adverse events.
多种抗炎药物已在心肌梗死（MI）后的二级预防中进行了测试，结果不一，这引发了对抗炎治疗疗效的质疑。尚未对抗炎药物进行直接比较。本研究旨在比较抗炎药物在MI后二级预防中的疗效和安全性，以及特定药物和给药策略的相对优点。
确定了MI后二级预防抗炎治疗的随机试验。主要疗效和安全性终点是试验定义的主要不良心血管事件（MACE）和严重不良事件。次要终点包括全因死亡、个体MACE成分、严重感染、癌症和胃肠道不良事件。除了网状Meta分析外，还进行了成对Meta分析，并对药物类型和给药时间进行了交互分析。进行了多次敏感性和Meta回归分析，以探索潜在的异质性来源。纳入了28项研究，涉及44406例患者，平均随访11个月。与对照组相比，抗炎治疗降低了MACE的发生率[发生率比（IRR）：0.92；95%置信区间（CI）：0.86 - 0.98]，且未增加严重不良事件。然而，它与胃肠道不良事件的发生率较高相关（IRR：1.21；95%CI：1.07 - 1.36）。未观察到抗炎治疗对MACE的影响与给药时间之间存在显著交互作用。
在MI的二级预防中，抗炎治疗可显著降低MACE，且不增加严重不良事件，但与胃肠道不良事件风险增加相关。
