Aspirin does not adversely affect survival in patients with stable congestive heart failure treated with angiotensin-converting enzyme inhibitors

被引:12
作者
Aumégeat, V [1 ]
Lamblin, N [1 ]
de Groote, P [1 ]
McFadden, EP [1 ]
Millaire, A [1 ]
Bauters, C [1 ]
Lablanche, JM [1 ]
机构
[1] Ctr Hosp Reg & Univ Lille, Hop Cardiol, Serv Cardiol C, F-59037 Lille, France
关键词
angiotensin-converting enzyme inhibitors; aspirin; heart failure; prognosis;
D O I
10.1378/chest.124.4.1250
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Experimental studies and retrospective analyses of mortality trials with angiotensin-converting enzyme inhibitors (ACE-Is) have suggested that aspirin may reduce the beneficial effect of these drugs. The aim of this study was to assess a possible detrimental effect of aspirin on survival in stable patients with left ventricular systolic dysfunction who had congestive heart failure and had been treated with ACE-Is. Methods and results: We performed a retrospective analysis in 755 consecutive stable patients with left ventricular systolic dysfunction. A Cox regression model was used to select independent predictors of survival and to test for a possible interaction between aspirin and ACE-Is with an adjustment to differences in clinical characteristics in subgroups of patients. Of the 755 patients, 328 (43.4%) had proven ischemic cardiomyopathy, 693 patients (91.8%) were receiving ACE-Is, and 317 patients were receiving aspirin (mean [+/- SD] dose, 183 +/- 65 mg/d; 74% of the patients receiving less than or equal to 200 mg/d). During a median follow-up period of 1,996 days, there were 273 cardiac-related deaths, 14 urgent transplantations, 71 nonurgent transplantations, and 46 noncardiac-related deaths, and 3 patients were lost to follow-up. The cardiovascular mortality rates were 11.5% and 19.0%, respectively, at 1 and 2 years. There were no interactions among aspirin, ACE-Is, and survival in the overall population (p = 0.21), or in subgroups of patients with ischemic cardiomyopathy (p = 0.41) or with nonischemic cardiomyopathy (p = 0.74). Conclusions: In this population of stable patients with left ventricular systolic dysfunction, our retrospective analysis did not demonstrate any interaction between the use of aspirin and survival in patients receiving ACE-Is.
引用
收藏
页码:1250 / 1258
页数:9
相关论文
共 25 条
[1]   Antiplatelet agents and survival: A cohort analysis from the studies of left ventricular dysfunction (SOLVD) trial [J].
Al-Khadra, AS ;
Salem, DN ;
Rand, WM ;
Udelson, JE ;
Smith, JJ ;
Konstam, MA .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1998, 31 (02) :419-425
[2]   Comparative study of ACE-inhibition, angiotensin II antagonism, and calcium channel blockade on flow-mediated vasodilation in patients with coronary disease (BANFF study) [J].
Anderson, TJ ;
Elstein, E ;
Haber, H ;
Charbonneau, F .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 35 (01) :60-66
[3]  
BAUR LHB, 1995, BRIT HEART J, V73, P227
[4]   Anticoagulant and antiplatelet therapy in heart failure [J].
Cleland, JGF .
CURRENT OPINION IN CARDIOLOGY, 1997, 12 (03) :276-287
[5]   Aspirin worsens exercise performance and pulmonary gas exchange in patients with heart failure who are taking angiotensin-converting enzyme inhibitors [J].
Guazzi, M ;
Pontone, G ;
Agostoni, P .
AMERICAN HEART JOURNAL, 1999, 138 (02) :254-260
[6]   Antihypertensive efficacy of angiotensin converting enzyme inhibition and aspirin counteraction [J].
Guazzi, MD ;
Campodonico, J ;
Celeste, F ;
Guazzi, M ;
Santambrogio, G ;
Rossi, M ;
Trabattoni, D ;
Alimento, M .
CLINICAL PHARMACOLOGY & THERAPEUTICS, 1998, 63 (01) :79-86
[7]   The aspirin-angiotensin-converting enzyme inhibitor tradeoff: To halve and halve not [J].
Hall, D .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 35 (07) :1808-1812
[8]   COUNTERACTION OF THE VASODILATOR EFFECTS OF ENALAPRIL BY ASPIRIN IN SEVERE HEART-FAILURE [J].
HALL, D ;
ZEITLER, H ;
RUDOLPH, W .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1992, 20 (07) :1549-1555
[9]   Effect of combined aspirin and angiotensin-converting enzyme inhibitor therapy versus angiotensin-converting enzyme inhibitor therapy alone on readmission rates in heart failure [J].
Harjai, KJ ;
Nunez, E ;
Turgut, T ;
Newman, J .
AMERICAN JOURNAL OF CARDIOLOGY, 2001, 87 (04) :483-+
[10]   Differential effects of quinaprilat and enalaprilat on endothelial function of conduit arteries in patients with chronic heart failure [J].
Hornig, B ;
Arakawa, N ;
Haussmann, D ;
Drexler, H .
CIRCULATION, 1998, 98 (25) :2842-2848