Use of First- and Second-Generation Cyclooxygenase-2–Selective Nonsteroidal Antiinflammatory Drugs and Risk of Acute Myocardial Infarction
Key result
Current use of COX-2 inhibitors, including etoricoxib (RR 2.09; 95% CI 1.10-3.97), rofecoxib, and celecoxib, significantly increased the risk of acute myocardial infarction compared to no NSAID use.
Why the study?
Does the current use of COX-2-selective and nonselective NSAIDs increase the risk of acute myocardial infarction compared to no use?
Population
17,561 patients drawn from a cohort of 486,378 persons registered within the United Kingdom General Practice…
Comparison
Current use of COX-2-selective NSAIDs and… vs No use of NSAIDs during the prior year.
Design
Case-control
Authors
Discussion
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Implication
Associated MI risk supports avoiding COX-2 inhibitors where possible; leaves open class-effect confirmation in randomized trials.
Study Design
Type
Case-Control (n=17,561)
Multicenter
Yes
Structured PICO
Does the current use of COX-2-selective and nonselective NSAIDs increase the risk of acute myocardial infarction compared to no use?
P
Population
17,561 patients (3,643 cases with acute myocardial infarction matched to 13,918 controls on age, sex, year of cohort entry, and general practice) drawn from a cohort of 486,378 persons registered within the United Kingdom General Practice Research Database with at least 1 prescription of an NSAID.
I
Intervention
Current use of COX-2-selective NSAIDs (etoricoxib, rofecoxib, celecoxib, valdecoxib) and nonselective NSAIDs (diclofenac).
C
Comparator
No use of NSAIDs during the prior year.
O
Outcome
Acute myocardial infarction (AMI).hard clinical
Main Result
Effect estimate: RR 2.09 (95% CI 1.10-3.97)
Current use of COX-2 inhibitors, including newer agents like etoricoxib, is associated with a dose-dependent increased risk of acute myocardial infarction, suggesting a class effect.
Cite This Study
Andersohn et al. (2006) conducted a case-control in Acute Myocardial Infarction (n=17,561). COX-2-selective and -nonselective NSAIDs vs. No use of NSAIDs during the prior year was evaluated on Acute myocardial infarction (RR 2.09, 95% CI 1.10-3.97). Current use of COX-2 inhibitors, including etoricoxib (RR 2.09; 95% CI 1.10-3.97), rofecoxib, and celecoxib, significantly increased the risk of acute myocardial infarction compared to no NSAID use.