Abstract 4497: Non-Selective NSAIDs Increase Incidence of Peri-Procedural Infarct and Prolong Hospital Stay after Percutaneous Coronary Interventions

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) increase risk of CV events. We sought to evaluate hospital outcomes associated with NSAID therapy in patients undergoing percutaneous coronary interventions (PCI). Data on NSAID use in single institution treated, consecutive PCI patients (treatment period 2004 –2006, rofecoxib-treated subjects excluded) was merged with NY State Angioplasty Registry database, and studied with ANOVA, chi-square, Kaplan-Meier, and logistic regression analyses. Of 2933 ASA-treated PCI patients (29% females) only 78 (2.7%) were treated with non-selective (ns) NSAIDs and 15 (0.5%) with Celecoxib. Most commonly used ns-NSAIDs were Ibuprofen (n=47) and Ketorolac (n=16). Most common indications for NSAIDs were musculoskeletal pain (35%) or “non-cardiac” chest pain (9%). NSAID-treated patients were younger (56+/−12 in ns-NSAID, 60+/−12 in Celecoxib, and 62+/−12 years old in “no NSAID” groups; p<0.001). More NSAID-treated patients had a history of myocardial infarction (p<0.001) or reduced ejection fraction (p=0.008). NSAIDs treatment did not affect post-PCI in-hospital mortality (p=0.769). However, post-procedural myocardial infarction (MI) was more common in ns-NSAID-treated patients (5% in ns-NSAID, 0% in Celecoxib, and 1% in “no NSAID” groups, p=0.002), odds ratio 5.4 (95%CI of 1.9 –15.9, p=0.002). Post-procedural length of stay in survivors was also significantly longer in the ns-NSAID group (3.9+/− 3.4 days), as compared to Celecoxib (1.1+/− 0.3 days) or “no NSAID” groups (2.2 +/−3.3 days; p<0.001). Ns-NSAID treatment remained predictive of prolonged hospital stay (p=0.011) after adjustment for age (p=0.033), ejection fraction (p<0.001), and history of previous (p<0.001) or post-procedural MI (p=0.001). We observed an increased incidence of peri-procedural MI and longer post-PCI length-of-stay in patients treated with non-selective NSAIDs, but not with Celecoxib. Poor outcomes in ns-NSAIDs treated PCI patients may be due to attenuation of aspirin’s anti-platelet effects by ns-NSAIDs. Pending results of the randomized trials, providers should limit use on non-selective NSAIDs in patients with coronary artery disease undergoing PCI.