Presentation: Use of Cyclooxygenase-2 Inhibitors in Patients with Myocardial Infarction and its Impact on Cardiovascular Outcome (2007)

826 Use of Cyclooxygenase-2 Inhibitors in Patients with Myocardial Infarction and its Impact on Cardiovascular Outcome

Purpose: The adverse effect of COX-2 inhibitors (Coxibs) on the cardiovascular system became apparent with the VIGOR randomized clinical trial. Nevertheless, even if several studies show an increased cardiovascular risk in users of coxibs, few studies show the impact of these drugs on mortality in the general population, and even fewer in the the high-risk population of patients who survived an acute myocardial infarction (AMI).
The objective of the study was to measure the 2-year impact of exposition to coxibs (ROFECOXIB and CELECOXIB) on mortality and recurrent MI in an exhaustive naturalistic cohort of individuals hospitalized for a AMI between 2000 and 2002 in Quebec.
Methods: We performed secondary analyses of medical-administrative data coming from the provincial registers. The cohort was constituted of all « new » patients aged 65 years and older living in Quebec, who survived a hospitalization for an AMI (ICD-9 code 410) in Quebec between 2000 and 2002. A 2-years follow-up period was considered. Main variables were the time until all-cause death, cardiovascular death (ICD-10 I20-I25, I44-I52) and the time until hospital readmission for AMI (ICD-9 code 410). Coxibs exposition was defined at each day of follow-up (value 1 if exposed at that day or the day before; 0 otherwise). Covariables included age, sex, comorbidity index, revascularization at index hospitalization, year of cohort entry, exposition to NSAIDs, and exposition to cardio-protective drugs. Cox proportional hazard models with time-dependent covariates were used.
Results: A total of 18,155 patients aged 65 years and older survived a hospitalization for AMI in Quebec between 2000 and 2002. During the 2-years follow-up, 4249 (23.4%) patients died, 2098 (11.6%) from cardiovascular cause, and 1921 patients (10.6%) were readmitted for an AMI. From the cohort, 4060 (22.4%) patients claimed at least one coxib prescription during the follow-up period (CELECOXIB: 2344; ROFECOXIB: 2311). Cox proportional hazard models adjusted for the other covariables show that patients exposed to ROFECOXIB have an increased risk of all-cause mortality (HR=1.297;p=0.0326), and of recurrent AMI (HR=1.697; p=0.0002) compared to non-exposed patients, but no difference in the risk of cardiovascular mortality (HR=1.030; p=0.8788). In patients exposed to CELECOXIB compared to non-exposed patients, there is no difference in these risks.
Conclusion: The study shows an increased risk of recurrent AMI in ROFECOXIB users without increasing the risk of cardiovascular death at 2 years, although there is an increased risk of all-cause death. No increased risk for recurrent AMI nor death was observed for CELECOXIB users. Further studies are needed to better understand the mechanisms implicated in these effects.

 A. Vanasse, None; J. Courteau, None; A.J. De-Brum Fernandes, None.