Aspirin Does Not Increase Heart Failure Events in Heart Failure Patients: From the WARCEF Trial.
Aspirin Does Not Increase Heart Failure Events in Heart Failure Patients: From the WARCEF Trial.
复制标题
阿司匹林不会增加心力衰竭患者的心力衰竭事件：来自 WARCEF 试验。
DOI：
10.1016/j.jchf.2017.04.011
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Anke
中科院分区：
文献类型：
--
作者：
Teerlink,JohnR;Qian,Min;Bello,NatalieA;Freudenberger,RonaldS;Levin,Bruce;DiTullio,MarcoR;Graham,Susan;Mann,DouglasL;Sacco,RalphL;Mohr,JP;Lip,GregoryYH;Labovitz,ArthurJ;Lee,SeitetzC;Ponikowski,Piotr;Lok,DirkJ;Anke
本研究的目的是确定阿司匹林是否增加了接受血管紧张素转换酶(ACE)抑制剂或血管紧张素受体阻滞剂(ARB)治疗的射血分数降低的心衰患者的心力衰竭(HF)住院或死亡率。背景由于其环氧合酶抑制特性，阿司匹林被认为增加了使用ACE抑制剂或ARB治疗的HF事件。我们使用传统的Cox模型比较了2,305名参加WARCEF(华法林与阿司匹林治疗心脏射血分数降低)试验(98.6%使用ACE抑制剂或ARB治疗)的患者发生心力衰竭事件(住院、死亡或两者兼而有之)的情况。结果调整基线协变量后，接受阿司匹林和华法林治疗的患者首次发生心力衰竭的时间没有差别(调整后的危险比：0.87；95%可信区间：0.72至1.04；p=0.117)或首次住院(调整后的危险比：0.88；95%可信区间：0.73~1.06；p=0.168)。在对协变量进行调整后，扩展的COX模型也没有发现所有心力衰竭事件或单独心力衰竭住院的显著差异。结论在WARCEF试验中，射血分数降低的心力衰竭患者中，服用阿司匹林和华法林治疗的患者发生心力衰竭事件的风险没有显著差异。(华法林与阿司匹林在降低心脏射血分数试验中的比较[WARCEF]；NCT00041938)
ObjectivesThe aim of this study was to determine whether aspirin increases heart failure (HF) hospitalization or death in patients with HF with reduced ejection fraction receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB).BackgroundBecause of its cyclooxygenase inhibiting properties, aspirin has been postulated to increase HF events in patients treated with ACE inhibitors or ARBs. However, no large randomized trial has addressed the clinical relevance of this issue.MethodsWe compared aspirin and warfarin for HF events (hospitalization, death, or both) in the 2,305 patients enrolled in the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial (98.6% on ACE inhibitor or ARB treatment), using conventional Cox models for time to first event (489 events). In addition, to examine multiple HF hospitalizations, we used 2 extended Cox models, a conditional model and a total time marginal model, in time to recurrent event analyses (1,078 events).ResultsAfter adjustment for baseline covariates, aspirin- and warfarin-treated patients did not differ in time to first HF event (adjusted hazard ratio: 0.87; 95% confidence interval: 0.72 to 1.04; p = 0.117) or first hospitalization alone (adjusted hazard ratio: 0.88; 95% confidence interval: 0.73 to 1.06; p = 0.168). The extended Cox models also found no significant differences in all HF events or in HF hospitalizations alone after adjustment for covariates.ConclusionsAmong patients with HF with reduced ejection fraction in the WARCEF trial, there was no significant difference in risk of HF events between the aspirin and warfarin-treated patients. (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction trial [WARCEF]; NCT00041938)