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Risk of ST versus non-ST elevation myocardial infarction associated with non-steroidal anti-inflammatory drugs
  1. Lamiae Grimaldi-Bensouda1,2,
  2. Michel Rossignol3,4,
  3. Nicolas Danchin5,6,
  4. P Gabriel Steg7,
  5. Gerard Bessede8,
  6. Michel Ovize9,
  7. Yves Cottin10,
  8. Elisabeth Autret-Leca11,
  9. Jacques Benichou12,13,
  10. Lucien Abenhaim14,15,
  11. for the PGRx-Myocardial Infarction Study Group*
  1. 1Equipe d'acceuil ‘Pharmacoépidémiologie et Maladies ’Infectieuses', Institut Pasteur, Paris, France
  2. 2LA-SER, Paris, France
  3. 3Epidemiology and Biostatistics, McGill University, Montreal, Canada
  4. 4LA-SER-CRR Inc, Montreal, Canada
  5. 5Service Maladies Coronaires, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
  6. 6Université Paris-Descartes, Paris, France
  7. 7Institut National de la Santé et de la Recherche Médicale (INSERM) U698, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris 7, Paris, France
  8. 8Service de Cardiologie, Centre Hospitalier de Guéret, Guéret, France
  9. 9INSERM U886, CIC de Lyon, Hospices Civils de Lyon, Lyon, France
  10. 10Service de Cardiologie, Centre Hospitalier Universitaire de Dijon, Dijon, France
  11. 11Service de Pharmacologie Clinique, Université François Rabelais, Tours, France
  12. 12Unité de Biométrie-Biostatistique, Centre Hospitalier Universitaire de Rouen, Rouen, France
  13. 13INSERM U657, Paris, France
  14. 14Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  15. 15LA-SER Ltd., London, UK
  1. Correspondence to Lamiae Grimaldi-Bensouda, LA-SER, 10 place de Catalogne, 75014 Paris, France; lgrimaldi{at}


Objective The objective of this study was to explore the association of non-steroidal anti-inflammatory drugs (NSAID) with ST-segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI).

Design, Setting & Patients A matched case–control study comparing patients with incident non-fatal myocardial infarction (MI) collected by cardiologists with controls. Cases were retrieved from the Pharmacoepidemiological General Research on Myocardial Infarction (PGRx-MI) registry, a French nationwide registry consisting of 55 cardiology centres, whereas controls were selected from general practice settings. Both cases and controls were recruited from the same geographically diverse areas across continental France.

Main Outcome Measures The association between NSAID and MI was assessed by matched adjusted OR from conditional logistic regression.

Results Between 2007 and 2009, 1125 incident cases were included (67.3% and 32.7% for STEMI and NSTEMI, respectively), with 2790 controls matched to MI cases by age and sex. Current use (previous 2 months) of either diclofenac or naproxen and other arylpropionic acid NSAID was not associated with STEMI (OR 0.9, 95% CI 0.4 to 1.9 and OR 1.0, 95% CI 0.6 to 1.7, respectively), instead it showed significant association with NSTEMI (OR 2.8, 95% CI 1.2 to 6.4 and OR 0.4, 95% CI 0.2 to 0.9, respectively). Our study confirms results from previously published analyses on the association of MI with NSAID (OR 1.5, 0.9, and 1.0 for diclofenac, naproxen and related NSAID, and all NSAID combined, respectively).

Conclusions Our study shows that the MI risk modification associated with NSAID is limited to NSTEMI.

  • Case–control studies
  • diclofenac
  • myocardial infarction
  • naproxen
  • risk assessment
  • risk stratification

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  • * Contributing members of the PGRx-Myocardial Infarction Study Group are listed in appendix 1.

  • Funding LA-SER is an independent research organisation that owns and develops the PGRx database. LA-SER has no commercial interests in any of the products studied. To study the data from PGRx or other sources, LA-SER receives funds and/or other support from regulatory agencies, public sources, academic institutions, private groups and from the pharmaceutical industry (donor companies include but not exclusively the following, over the past 36 months: AstraZeneca, Boiron, Expanscience, Genevrier, GSK, Janssen-Cilag, Merck/Shering Plough, Negma/Wokhardt, Novartis, Pfizer, several divisions of Sanofi).

  • Competing interests LGB was the recipient of a research fellowship from INSERM at the time of the study and is currently employed by LA-SER together with MR. PGS's institution has received a research grant from Servier (2009–14), and PGS has received consulting and speaker's fees from Astellas Pharma, AstraZeneca, Bayer, Boehringer-Ingelheim, BMS, Daiichi Sankyo-Lilly, GSK, Medtronic, MSD, Otsuka, Pfizer, Roche, Sanofi-Aventis, Servier and The Medicines Company. PGS declares being a stockholder in Aterovax. MR, ND, PGB, MO, YC, EAL and JB declare having no conflicts of interest. LA is a stockowner and chairman of LA-SER, the company conducting the study.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the PGRx-MI and PGRx-GP registries and the study protocols were submitted to the ethics committee of Paris-Ile de France III and have been approved by CNIL, the French Data Protection Authority (Commission Nationale de l'Informatique et des Libertes).

  • Provenance and peer review Not commissioned; externally peer reviewed.