Key result
New exposure to rofecoxib increased the risk of subsequent AMI (HR 2.47; 95% CI 1.57-3.89), and new NSAID use increased the risk of death, whereas celecoxib did not increase these risks.
Why the study?
Does exposure to coxibs and NSAIDs increase the risk of morbidity and mortality in older patients who survived an acute myocardial infarction?
Case-Control (n=19,823)
Does exposure to coxibs and NSAIDs increase the risk of morbidity and mortality in older patients who survived an acute myocardial infarction?
In older survivors of acute myocardial infarction, the use of rofecoxib and non-selective NSAIDs, but not celecoxib, is associated with an increased risk of recurrent AMI and adverse clinical outcomes.
May increase recurrent AMI/mortality risk with rofecoxib or NSAIDs post-MI; leaves open celecoxib safety, needing RCT confirmation.
The objective was to measure the impact of exposure to coxibs and non-steroidal antiinflammatory drugs (NSAID) on morbidity and mortality in older patients with acute myocardial infarction (AMI). A nested case-control study was carried out using an exhaustive population-based cohort of patients aged 66 years and older living in Quebec (Canada) who survived a hospitalization for AMI (ICD-9 410) between 1999 and 2002. The main variables were all-cause and cardiovascular (CV) death, subsequent hospital admission for AMI, and a composite end-point including recurrent AMI or CV death. Conditional logistic regressions were used to estimate the risk of mortality and morbidity. A total of 19,823 patients aged 66 years and older survived hospitalization for AMI in the province of Quebec between 1999 and 2002. After controlling for covariables, the risk of subsequent AMI and the risk of composite end-point were increased by the use of rofecoxib. The risk of subsequent AMI was particularly high for new rofecoxib users (HR 2.47, 95% CI 1.57-3.89). No increased risk was observed for celecoxib users. No increased risk of CV death was observed for patients exposed to coxibs or NSAIDs. Patients newly exposed to NSAIDs were at an increased risk of death (HR 2.22, 95% CI 1.30-3.77) and of composite end-point (HR 2.28, 95% CI 1.35-3.84). Users of rofecoxib and NSAIDs, but not celecoxib, were at an increased risk of recurrent AMI and of composite end-point. Surprisingly, no increased risk of CV death was observed. Further studies are needed to better understand these apparently contradictory results.
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Vanasse et al. (2009) conducted a case-control in acute myocardial infarction (n=19,823). Coxibs (rofecoxib, celecoxib) and NSAIDs vs. Unexposed patients was evaluated on subsequent hospital admission for AMI (HR 2.47, 95% CI 1.57-3.89). New exposure to rofecoxib increased the risk of subsequent AMI (HR 2.47; 95% CI 1.57-3.89), and new NSAID use increased the risk of death, whereas celecoxib did not increase these risks.
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