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Clinical Investigations: CARDIOLOGY |

Aspirin Does Not Adversely Affect Survival in Patients With Stable Congestive Heart Failure Treated With Angiotensin-Converting Enzyme Inhibitors*

Valérie Aumégeat; Nicolas Lamblin; Pascal de Groote; Eugène P. Mc Fadden; Alain Millaire; Christophe Bauters; Jean-Marc Lablanche
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*From the Service de Cardiologie C, Hôpital Cardiologique, CHRU Lille, Bd Prof J Leclercq, 59037 Lille Cedex, France.

Correspondence to: Pascal de Groote, MD, Service de Cardiologie C, Hôpital Cardiologique, CHRU, Bd du Prof J Leclercq, 59037 Lille Cedex, France; e-mail: pdegroote@chru-lille.fr



Chest. 2003;124(4):1250-1258. doi:10.1378/chest.124.4.1250
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Background: Experimental studies and retrospective analyses of mortality trials with angiotensin-converting enzyme inhibitors (ACE-Is) have suggested that aspirin may reduce the beneficial effect of these drugs. The aim of this study was to assess a possible detrimental effect of aspirin on survival in stable patients with left ventricular systolic dysfunction who had congestive heart failure and had been treated with ACE-Is.

Methods and results: We performed a retrospective analysis in 755 consecutive stable patients with left ventricular systolic dysfunction. A Cox regression model was used to select independent predictors of survival and to test for a possible interaction between aspirin and ACE-Is with an adjustment to differences in clinical characteristics in subgroups of patients. Of the 755 patients, 328 (43.4%) had proven ischemic cardiomyopathy, 693 patients (91.8%) were receiving ACE-Is, and 317 patients were receiving aspirin (mean [± SD] dose, 183 ± 65 mg/d; 74% of the patients receiving ≤ 200 mg/d). During a median follow-up period of 1,996 days, there were 273 cardiac-related deaths, 14 urgent transplantations, 71 nonurgent transplantations, and 46 noncardiac-related deaths, and 3 patients were lost to follow-up. The cardiovascular mortality rates were 11.5% and 19.0%, respectively, at 1 and 2 years. There were no interactions among aspirin, ACE-Is, and survival in the overall population (p = 0.21), or in subgroups of patients with ischemic cardiomyopathy (p = 0.41) or with nonischemic cardiomyopathy (p = 0.74).

Conclusions: In this population of stable patients with left ventricular systolic dysfunction, our retrospective analysis did not demonstrate any interaction between the use of aspirin and survival in patients receiving ACE-Is.

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