|编译服务：||心血管疾病防治||编译者：||张燕舞||编译时间：||May 22, 2018||浏 览 量：||6|
阿司匹林对心力衰竭窦性心律患者的安全性和有效性尚不确定。 在对无心房颤动病史的心力衰竭患者进行的一项登记研究中，3840名服用小剂量阿司匹林的患者倾向于同样数量的未服用阿司匹林的患者倾向匹配阿司匹林和非阿司匹林组的死亡率和卒中率相似。 然而，在阿司匹林组中观察到较高的心力衰竭再入院率，这在一些但不是全部的先前研究中已经观察到。 阿司匹林的使用也与心肌梗塞风险增加有关，但不能排除残余混杂。 我们建议不要使用阿司匹林治疗心力衰竭患者，而没有针对这种治疗的具体指征。
OBJECTIVES This study sought to assess safety and effectiveness of low-dose aspirin in heart failure (HF) not complicated by atrial fibrillation.
BACKGROUND Despite lack of evidence, low-dose aspirin is widely used in patients with HF and sinus rhythm with and without prior ischemic heart disease.
METHODS The study included 12,277 patients with new-onset HF during 2007 to 2012 who had no history of atrial fibrillation. Of 5,450 patients using low-dose aspirin at baseline, 3,840 were propensity matched to non-aspirin users in a 1:1 ratio. Propensity-matched Cox models were calculated with respect to the primary composite outcome of all-cause mortality, myocardial infarction, and stroke and the secondary outcomes of bleeding and HF readmission.
RESULTS The composite outcome occurred in 1,554 (40.5%) patients in the aspirin group and 1,604 (41.8%) patients in the non-aspirin group. Aspirin use was not associated with an altered risk of composite outcome (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.91 to 1.05), but it was associated with an increased risk of myocardial infarction (HR: 1.34; 95% CI: 1.08 to 1.67), whereas no differences were observed in all-cause mortality and stroke. An increased risk of HF readmission was observed in the aspirin group (HR: 1.25; 95% CI: 1.17 to 1.33). No difference in bleeding was observed. In subgroup analyses on the basis of a history of ischemic heart disease, the results were similar to the main result.
CONCLUSIONS No association was detected between low-dose aspirin use and the composite outcome of all-cause mortality,