Risk of myocardial infarction associated with selective COX‐2 inhibitors: Meta‐analysis of randomised controlled trials

Abstract

Purpose To evaluate the risk of myocardial infarction (MI) associated with the use of selective cyclooxygenase‐2 (COX‐2) inhibitors (coxibs). Methods Systematic review and meta‐analysis of randomised controlled trials (RCTs) using a fixed‐effect model to estimate the odds ratios (ORs) for risk of MI associated with coxibs compared against placebo, non‐steroidal anti‐inflammatory drugs (NSAIDs) and other coxibs. Results Fifty‐five trials (99 087 patients) were included in the meta‐analysis. The overall pooled OR for MI risk for any coxib compared against placebo was 1.46 (95%CI: 1.02, 2.09). We found celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib were associated with higher MI risks compared against placebo. The pooled OR for any coxib compared against other NSAIDs was 1.45 (95%CI: 1.09, 1.93). Rofecoxib had a significantly higher risk of MI than naproxen (OR: 5.39; 95%: 2.08, 14.02) and valdecoxib had lower MI risk than diclofenac (OR: 0.14, 95%CI: 0.03, 0.73). There were no significant differences identified in the risk of MI from the available head‐to‐head comparisons of coxibs. Conclusions Coxibs were associated with increased risks of MI when compared against placebo or non‐selective NSAIDs. Differences in MI risk were also apparent between comparisons of individual NSAIDs. Future work should consider using individual patient data (IPD) meta‐analysis to explore differences in MI risk between different subgroups of patients. Copyright © 2007 John Wiley & Sons, Ltd.