Nonsteroidal antiinflammatory drugs after acute myocardial infarction

Background Many older patients undergo therapy with nonsteroidal antiinflammatory drugs (NSAIDs), medications that produce effects on platelets and inflammation similar to those produced with aspirin. The impact of these agents on mortality after acute myocardial infarction is not known. We sought to determine whether the use of NSAIDs alone, or in addition to aspirin, is associated with a lower 1-year mortality rate in elderly patients after acute myocardial infarction. Methods We performed an analysis of the Cooperative Cardiovascular Project, a retrospective medical record review that included demographic and clinical information for Medicare beneficiaries hospitalized with a diagnosis of acute myocardial infarction during 1994 and 1995. The cohort included 48,584 elderly patients with acute myocardial infarction without contraindications to NSAID or aspirin therapy. There were 736 patients (1.5%) who were prescribed NSAIDs alone, 36,211 (74.5%) prescribed aspirin alone, 2096 (4.3%) prescribed both NSAIDs and aspirin, and 9541 (19.6%) prescribed neither medication at discharge. Results Compared with patients discharged with neither medication, prescriptions of NSAID therapy alone (hazard ratio [HR], 0.77; 95% CI, 0.65-0.90), aspirin alone (HR, 0.81; 95% CI, 0.77-0.86), and both medications (HR, 0.78; 95% CI, 0.69-0.88) were associated with lower adjusted 1-year mortality rates. Compared with patients prescribed NSAID therapy at discharge, there was no significant benefit associated with the addition of aspirin, and the benefit of NSAID therapy was not significantly different from that of aspirin alone. Conclusion The prescription of NSAID therapy at hospital discharge for elderly Medicare beneficiaries who survived acute myocardial infarction was associated with similarly lower 1-year mortality rates as compared with aspirin therapy. The addition of aspirin to NSAID therapy was not associated with an additional survival benefit. (Am Heart J 2002;143:475-81.)