TY - JOUR

T1 - Impact of aspirin and statins on long-term survival in patients hospitalized with acute myocardial infarction complicated by heart failure

T2 - an analysis of 1706 patients

AU - Lewinter, Christian

AU - Bland, John M

AU - Crouch, Simon

AU - Cleland, John G F

AU - Doherty, Patrick

AU - LeWinter, Martin M

AU - Køber, Lars

AU - Hall, Alistair S

AU - Gale, Christopher P

N1 - © 2013 The Authors. European Journal of Heart Failure © 2013 European Society of Cardiology.

PY - 2014/1

Y1 - 2014/1

N2 - 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.

AB - 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.

KW - Aged

KW - Aged, 80 and over

KW - Aspirin

KW - Cyclooxygenase Inhibitors

KW - Drug Therapy, Combination

KW - Follow-Up Studies

KW - Great Britain

KW - Heart Failure

KW - Humans

KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors

KW - Inpatients

KW - Male

KW - Myocardial Infarction

KW - Prognosis

KW - Prospective Studies

KW - Survival Rate

KW - Time Factors

U2 - 10.1002/ejhf.40

DO - 10.1002/ejhf.40

M3 - Journal article

C2 - 24453098

VL - 16

SP - 95

EP - 102

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1567-4215

IS - 1

ER -