Key result
Selective COX-2 inhibitors were associated with an increased risk of myocardial infarction compared to placebo (OR 1.46; 95% CI 1.02-2.09) and non-selective NSAIDs (OR 1.45; 95% CI 1.09-1.93).
Why the study?
Do selective COX-2 inhibitors increase the risk of myocardial infarction compared to placebo or non-selective NSAIDs?
Meta-Analysis (n=99,087)
Do selective COX-2 inhibitors increase the risk of myocardial infarction compared to placebo or non-selective NSAIDs?
Odds Ratio: 1.46 (95% CI 1.02–2.09)
Selective COX-2 inhibitors are associated with a significantly increased risk of myocardial infarction compared to placebo or non-selective NSAIDs.
Supports avoiding selective COX-2 inhibitors in high cardiovascular-risk patients; confirms increased MI hazard versus placebo and non-selective NSAIDs.
PURPOSE: To evaluate the risk of myocardial infarction (MI) associated with the use of selective cyclooxygenase-2 (COX-2) inhibitors (coxibs). METHODS: Systematic review and meta-analysis of randomised controlled trials (RCTs) using a fixed-effect model to estimate the odds ratios (ORs) for risk of MI associated with coxibs compared against placebo, non-steroidal anti-inflammatory drugs (NSAIDs) and other coxibs. RESULTS: Fifty-five trials (99 087 patients) were included in the meta-analysis. The overall pooled OR for MI risk for any coxib compared against placebo was 1.46 (95%CI: 1.02, 2.09). We found celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib were associated with higher MI risks compared against placebo. The pooled OR for any coxib compared against other NSAIDs was 1.45 (95%CI: 1.09, 1.93). Rofecoxib had a significantly higher risk of MI than naproxen (OR: 5.39; 95%: 2.08, 14.02) and valdecoxib had lower MI risk than diclofenac (OR: 0.14, 95%CI: 0.03, 0.73). There were no significant differences identified in the risk of MI from the available head-to-head comparisons of coxibs. CONCLUSIONS: Coxibs were associated with increased risks of MI when compared against placebo or non-selective NSAIDs. Differences in MI risk were also apparent between comparisons of individual NSAIDs. Future work should consider using individual patient data (IPD) meta-analysis to explore differences in MI risk between different subgroups of patients.
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Chen et al. (2007) reported a meta-analysis. Selective COX-2 inhibitors (coxibs) vs. Placebo or non-steroidal anti-inflammatory drugs (NSAIDs) was evaluated on Myocardial infarction (OR 1.46, 95% CI 1.02, 2.09). Selective COX-2 inhibitors were associated with an increased risk of myocardial infarction compared to placebo (OR 1.46; 95% CI 1.02-2.09) and non-selective NSAIDs (OR 1.45; 95% CI 1.09-1.93).
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