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J Am Coll Cardiol, 2005; 46:967-974, doi:10.1016/j.jacc.2005.06.049 © 2005 by the American College of Cardiology Foundation |
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* Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
Colorado Foundation for Medical Care, Aurora, Colorado
Division of Cardiology, Denver Health Medical Center, Denver, Colorado
Divisions of Cardiology and Geriatric Medicine, University of Colorado Health Sciences Center, Denver, Colorado
|| Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
¶ Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
# Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
Manuscript received July 30, 2004; revised manuscript received April 11, 2005, accepted April 19, 2005.
* Address for correspondence: Dr. Harlan M. Krumholz, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208088, New Haven, Connecticut 06520. (Email: harlan.krumholz{at}yale.edu).
Prior Aspirin Use and Outcomes in Elderly Patients Hospitalized With Acute Myocardial Infarction
Edward L. Portnay, JoAnne M. Foody, Saif S. Rathore, Yongfei Wang, Frederick A. Masoudi, Jeptha P. Curtis, Harlan M. Krumholz
We examined the association between prior aspirin use and mortality at one month and six months in 118,992 elderly patients and prior aspirin use and readmissions in 78,975 elderly patients with myocardial infarction (MI) in a national sample. After multivariable adjustment, prior aspirin use was associated with lower risk of one-month mortality (relative risk 0.93, 95% confidence interval [CI] 0.90 to 0.96) and six-month mortality (hazard ratio 0.94, 95% CI 0.91 to 0.96). Prior aspirin use tended to reduce all-cause or coronary artery disease readmission at one month or six months. Prior aspirin use is not a marker of increased mortality in elderly patients hospitalized with MI.
OBJECTIVES: We sought to assess the association between prior aspirin use and mortality, all-cause readmission, and condition-specific readmission at one month and six months in a national sample of Medicare beneficiaries hospitalized with a confirmed myocardial infarction (MI).
BACKGROUND: Prior aspirin use is considered a marker of higher risk in patients with MI, yet the prognostic significance of this factor has been debated.
METHODS: Medicare beneficiaries 
65 years old hospitalized with MI were evaluated to determine whether there was an association between prior aspirin use and mortality (n = 118,992), all-cause readmission, and condition-specific readmission (n = 78,975) at one month and six months.
RESULTS: One-third of the patients (n = 39,531, 33.2%) were using aspirin before admission. Those with prior aspirin use had significantly lower mortality at one month (16.1% vs. 19.0%, p < 0.0001) and six months (24.7% vs. 27.5%, p < 0.0001). After multivariable adjustment, prior aspirin use was found to be associated with a lower risk of one-month (relative risk ratio 0.93, 95% confidence interval [CI] 0.90 to 0.96) and six-month mortality (hazard ratio 0.94, 95% CI 0.91 to 0.96). Prior aspirin use tended to reduce all-cause or coronary artery disease readmissions at one month or six months.
CONCLUSIONS: Prior aspirin use is not a marker of increased mortality in patients 65 years old hospitalized with MI.
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