Lewinter, Christian4; Bland, John M3; Crouch, Simon3; Cleland, John G F3; Doherty, Patrick3; LeWinter, Martin M3; Køber, Lars5; Hall, Alistair S3; Gale, Christopher P3
1 Section for Metabolic Genetics, Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, Københavns Universitet2 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet3 unknown4 Section for Metabolic Genetics, Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, Københavns Universitet5 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
an analysis of 1706 patients
AIMS: Aspirin and statins are established therapies for acute myocardial infarction (MI), but their benefits in patients with chronic heart failure (HF) remain elusive. We investigated the impact of aspirin and statins on long-term survival in patients hospitalized with acute MI complicated by HF. METHODS AND RESULTS: Of 4251 patients in the Evaluation of Methods and Management of Acute Coronary Events (EMMACE)-1 and -2 observational studies, 1706 patients had HF. A propensity score-matching method estimated the average treatment effects (ATEs) of aspirin and statins on survival over 90 months. ATEs were calculated as relative risk differences in all-cause mortality comparing patients receiving aspirin and statins with controls, respectively. Moreover, combined aspirin and statins vs. none (ATE I), aspirin or statins vs. none (ATE II), and aspirin and statins vs. aspirin or statins (ATE III) were assessed. The median survival times of the ATE I, ATE II and ATE III were 25, 50, and 85 months, respectively. Regarding aspirin, the ATE was significantly improved at 6, 12, and 90 months [ATE 6 months: 10%, 95% confidence interval (CI) 3-18%], where the ATE of statins favoured survival at 1-24 months (ATE 1 month: 5%, 95% CI 0.3-10%). Mortality was lower at 1, 6, and 24 months in those who received aspirin and statins (ATE I). When the combination was compared with either treatment alone, an effect persisted between 6 and 90 months (ATE III). CONCLUSION: In patients with acute MI complicated by HF, prescription of aspirin and statins either alone or together was associated with better long-term survival.
European Journal of Heart Failure, 2014, Vol 16, Issue 1, p. 95-102
Aged; Aged, 80 and over; Aspirin; Cyclooxygenase Inhibitors; Drug Therapy, Combination; Follow-Up Studies; Great Britain; Heart Failure; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Inpatients; Male; Myocardial Infarction; Prognosis; Prospective Studies; Survival Rate; Time Factors