| Autor: |
John Kjekshus, Khang Ngoc Nguyen, Ivar Aursnes, Steve Snapinn |
| Rok vydání: |
1995 |
| Předmět: |
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| Zdroj: |
Journal of the American College of Cardiology. 25(2) |
| ISSN: |
0735-1097 |
| DOI: |
10.1016/0735-1097(95)91553-a |
| Popis: |
Several drugs have been investigated regarding their effect on mortality when given early after an acute myocardial infarction. The use of angiotensinconverting enzyme (ACE) inhibitors has been studied in several trials with inconsistent results. Aspirin (ASA) has become a well documented therapeutic adjunct in patients with coronary heart disease. Attention has recently been focused on a possible interaction between aspirin and ACE inhibitors. We therefore reanalyzed data from the CONSENSUS II to find any evidence of differential effects of the ACE inhibitor enalapril in subgroups defined by use of ASA at baseline. Stepwise logistic regression tested the multiplicative interaction. The enalapril-ASA interaction term was a significant predictor of at the end of the study (odds ratio 1.442, p = 0.047), and was a borderline-significant predictor of mortality 30 days after randomization (odds ratio 1.450, p = 0.085). We used Rothman synergy index S to examine the postulated interaction with departure from an additive model. S would be equal to unity under additivity, and less than unity when suggesting antagonism. The synergy index was 0.66 (95% confidence interval 0.46 to 0.94) for mortality at the end of the study, and 0.68 (0.44 to 1.04) for 30-day mortality, indicating antagonism between enalapril and ASA. No significant interaction was found regarding nonfatal major events. Conclusion We found evidence of enalapril-ASA interaction. Excess mortality occurred when enalapril was randomized to patients using ASA at baseline. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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