Nonsteroidal Anti-Inflammatory Drugs and Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Surgery

Flávio de Souza Brito, Rajendra H. Mehta, Renato D. Lopes, Ralf E. Harskamp, B. Daniel Lucas, Phillip Schulte, Jean Claude Tardif, John H. Alexander

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in perioperative pain management of patients undergoing coronary artery bypass graft surgery. However, the association of periprocedural use of NSAIDs and clinical outcomes after coronary artery bypass graft is understudied. Methods We conducted a retrospective analysis using pooled data from 2 multicenter randomized controlled trials (PREVENT IV [n = 3014] and MEND-CABG II [n = 3023]). Rates of death, death or myocardial infarction, and death, myocardial infarction, or stroke in the 30 days following coronary artery bypass graft surgery were compared in patients using or not using perioperative NSAIDs. Inverse probability of treatment weighting and Cox proportional hazards regression models were used to adjust for confounding. Results A total of 5887 patients were studied. Median age was 65 years, 78% were male, and 91% were White. NSAIDs were used in 2368 (40.2%) patients. The majority of patients (1822 [30.9%]) received NSAIDs after coronary artery bypass graft surgery; 289 (4.9%) used them prior to and after the surgery; and 257 (4.4) received NSAIDs prior to the surgery only. Adjusted 30-day outcomes were similar in patients receiving and not receiving NSAIDs (death: hazard ratio [HR] 1.18; 95% confidence interval [CI], 0.48-2.92; death or myocardial infarction: HR 0.87; 95% CI, 0.42-1.79; death, myocardial infarction, or stroke: HR 0.87; 95% CI, 0.46-1.65). Conclusion In this pooled data analysis, perioperative NSAID use was common among patients undergoing coronary artery bypass graft surgery and was not associated with an increased short-term risk for major adverse clinical outcomes.

Original languageEnglish (US)
Pages (from-to)462-468
Number of pages7
JournalAmerican Journal of Medicine
Volume130
Issue number4
DOIs
StatePublished - Apr 1 2017

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Coronary Artery Bypass
Anti-Inflammatory Agents
Pharmaceutical Preparations
Transplants
Myocardial Infarction
Confidence Intervals
Stroke
Pain Management
Proportional Hazards Models
Randomized Controlled Trials
Mortality

Keywords

  • Clinical outcomes
  • Coronary bypass graft surgery
  • NSAID

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Nonsteroidal Anti-Inflammatory Drugs and Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Surgery. / de Souza Brito, Flávio; Mehta, Rajendra H.; Lopes, Renato D.; Harskamp, Ralf E.; Lucas, B. Daniel; Schulte, Phillip; Tardif, Jean Claude; Alexander, John H.

In: American Journal of Medicine, Vol. 130, No. 4, 01.04.2017, p. 462-468.

Research output: Contribution to journalArticle

de Souza Brito, F, Mehta, RH, Lopes, RD, Harskamp, RE, Lucas, BD, Schulte, P, Tardif, JC & Alexander, JH 2017, 'Nonsteroidal Anti-Inflammatory Drugs and Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Surgery', American Journal of Medicine, vol. 130, no. 4, pp. 462-468. https://doi.org/10.1016/j.amjmed.2016.10.023
de Souza Brito, Flávio ; Mehta, Rajendra H. ; Lopes, Renato D. ; Harskamp, Ralf E. ; Lucas, B. Daniel ; Schulte, Phillip ; Tardif, Jean Claude ; Alexander, John H. / Nonsteroidal Anti-Inflammatory Drugs and Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Surgery. In: American Journal of Medicine. 2017 ; Vol. 130, No. 4. pp. 462-468.
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AU - de Souza Brito, Flávio

AU - Mehta, Rajendra H.

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AU - Harskamp, Ralf E.

AU - Lucas, B. Daniel

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AU - Tardif, Jean Claude

AU - Alexander, John H.

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N2 - Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in perioperative pain management of patients undergoing coronary artery bypass graft surgery. However, the association of periprocedural use of NSAIDs and clinical outcomes after coronary artery bypass graft is understudied. Methods We conducted a retrospective analysis using pooled data from 2 multicenter randomized controlled trials (PREVENT IV [n = 3014] and MEND-CABG II [n = 3023]). Rates of death, death or myocardial infarction, and death, myocardial infarction, or stroke in the 30 days following coronary artery bypass graft surgery were compared in patients using or not using perioperative NSAIDs. Inverse probability of treatment weighting and Cox proportional hazards regression models were used to adjust for confounding. Results A total of 5887 patients were studied. Median age was 65 years, 78% were male, and 91% were White. NSAIDs were used in 2368 (40.2%) patients. The majority of patients (1822 [30.9%]) received NSAIDs after coronary artery bypass graft surgery; 289 (4.9%) used them prior to and after the surgery; and 257 (4.4) received NSAIDs prior to the surgery only. Adjusted 30-day outcomes were similar in patients receiving and not receiving NSAIDs (death: hazard ratio [HR] 1.18; 95% confidence interval [CI], 0.48-2.92; death or myocardial infarction: HR 0.87; 95% CI, 0.42-1.79; death, myocardial infarction, or stroke: HR 0.87; 95% CI, 0.46-1.65). Conclusion In this pooled data analysis, perioperative NSAID use was common among patients undergoing coronary artery bypass graft surgery and was not associated with an increased short-term risk for major adverse clinical outcomes.

AB - Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in perioperative pain management of patients undergoing coronary artery bypass graft surgery. However, the association of periprocedural use of NSAIDs and clinical outcomes after coronary artery bypass graft is understudied. Methods We conducted a retrospective analysis using pooled data from 2 multicenter randomized controlled trials (PREVENT IV [n = 3014] and MEND-CABG II [n = 3023]). Rates of death, death or myocardial infarction, and death, myocardial infarction, or stroke in the 30 days following coronary artery bypass graft surgery were compared in patients using or not using perioperative NSAIDs. Inverse probability of treatment weighting and Cox proportional hazards regression models were used to adjust for confounding. Results A total of 5887 patients were studied. Median age was 65 years, 78% were male, and 91% were White. NSAIDs were used in 2368 (40.2%) patients. The majority of patients (1822 [30.9%]) received NSAIDs after coronary artery bypass graft surgery; 289 (4.9%) used them prior to and after the surgery; and 257 (4.4) received NSAIDs prior to the surgery only. Adjusted 30-day outcomes were similar in patients receiving and not receiving NSAIDs (death: hazard ratio [HR] 1.18; 95% confidence interval [CI], 0.48-2.92; death or myocardial infarction: HR 0.87; 95% CI, 0.42-1.79; death, myocardial infarction, or stroke: HR 0.87; 95% CI, 0.46-1.65). Conclusion In this pooled data analysis, perioperative NSAID use was common among patients undergoing coronary artery bypass graft surgery and was not associated with an increased short-term risk for major adverse clinical outcomes.

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