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Antiplatelet agents and survival: a cohort analysis from the Studies of Left Ventricular Dysfunction (SOLVD) trial
A S Al-Khadra1, D N Salem, W M Rand
1Department of Medicine, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Insights
Antiplatelet agents (APAs) significantly improve survival and reduce heart failure hospitalizations in patients with left ventricular systolic dysfunction. APA use showed retained but reduced benefit from enalapril therapy.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Antiplatelet agents (APAs) are crucial for coronary disease management.
- The impact of APAs in patients with left ventricular (LV) systolic dysfunction remains unclear.
Purpose of the Study:
- To evaluate the association between antiplatelet agent (APA) use and survival and cardiac morbidity in patients with LV systolic dysfunction.
Main Methods:
- Analysis of 6,797 patients from the Studies of Left Ventricular Dysfunction (SOLVD) trial.
- Cox regression used to assess all-cause mortality and death/hospital admission for heart failure (HF).
- Adjusted for baseline characteristics and tested for interactions with APA use.
Main Results:
- APA use (46.3%) was linked to significantly lower all-cause mortality (aHR 0.82) and reduced risk of death or HF hospitalization (aHR 0.81).
- No influence of APA use on outcomes based on trial assignment, gender, LV ejection fraction, or NYHA class.
- Significant interaction between APA use and enalapril therapy observed, with enalapril reducing death/HF hospitalization in APA users.
Conclusions:
- APA use is associated with improved survival and reduced cardiac morbidity in patients with LV systolic dysfunction.
- These benefits persist after adjusting for baseline characteristics.
- APA use modifies the benefit of enalapril therapy, retaining but reducing its effect on survival.
Objectives:
This study sought to evaluate the relation between antiplatelet agent (APA) use and survival and morbidity from cardiac disease in patients with left ventricular (LV) systolic dysfunction.
Background:
APAs play an important role in the prevention and treatment of coronary disease. Their effects in patients with LV systolic dysfunction are unknown.
Methods:
We reviewed data on APA use in 6,797 patients enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) trial and analyzed the relation between their use and all-cause mortality as well as the combined end point of death or hospital admission for heart failure (HF). We used Cox regression to adjust for differences in baseline characteristics and to test for the interaction between APA use and selected patient variables in relation to outcome.
Results:
APA use (46.3% of patients) was associated with significantly reduced mortality from all causes (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.73 to 0.92, p = 0.0005) and reduced risk of death or hospital admission for HF (adjusted HR 0.81, 95% CI 0.74 to 0.89, p < 0.0001) but was not influenced by trial assignment, gender, LV ejection fraction, New York Heart Association class or etiology. A strong interaction was observed among APA use, randomization group and all-cause mortality. The association between APA use and survival was not observed in the enalapril group, nor was an enalapril benefit on survival detectable in patients receiving APAs at baseline. However, randomization to enalapril therapy significantly reduced the combined end point of death or hospital admission for HF in APA users.
Conclusions:
In patients with LV systolic dysfunction, use of APAs is associated with improved survival and reduced morbidity. This association is retained after adjustment for baseline characteristics. APA use is associated with retained but reduced benefit from enalapril.