Non-steroidal anti-inflammatory drug use after invasive and non-invasive diagnostic procedures for coronary artery disease by the degree of disease: a Danish drug utilization study (2008-2021)

Abstract Background Non-steroidal anti-inflammatory drugs (NSAIDs) increase cardiovascular risk and are therefore not recommended for patients with cardiovascular disease. No study has investigated NSAID use according to the degree of coronary artery disease (CAD) as assessed by different diagnostic procedures. Aim To investigate temporal trends in the prevalence of NSAID use in patients with varying degrees of CAD, diagnosed with non-invasive or with invasive procedures. Methods We conducted a drug utilization study based on healthcare data from the western part of Denmark (3.3 million inhabitants). All patients who underwent examination for CAD were identified from the Western Denmark Heart Registry and categorized into three cohorts based on diagnostic procedures: non-invasive approaches comprising coronary computed tomography angiography (CCTA) (2008 to 2021, n=114,016), myocardial perfusion imaging (MPI) (2017 to 2021, n=21,154), and all invasive coronary angiograms (CAGs) performed from 2008 to 2021 (n=172,670). NSAID use was identified from prescriptions registered in the Danish National Prescription Registry. We calculated the one-year prevalence proportion of NSAID use following first-time diagnostic procedures, stratified by degree of CAD. Patients in the CCTA cohort were categorized as having no CAD, non-obstructive CAD, or obstructive CAD; patients in the MPI cohort were categorized as having 10% reversible ischemia or 10% reversible ischemia; and patients who had undergone CAG were classified as having no (0%), no significant (1–49%), or significant (50%) diameter stenosis. Results In the CAG and CCTA cohorts, one-year NSAID use declined over the study period, regardless of CAD degree (Figure 1). The most pronounced annual decline was observed in patients with significant diameter stenosis diagnosed with CAG, with an average annual reduction of 4.7%. In 2021, the one-year prevalence of NSAID use was 13% in patients with obstructive CAD diagnosed by CCTA vs. 21% in patients with no obstructive CAD found by CCTA, 8% in patients with 10% reversible ischemia vs. 13% in patients with 10% reversible ischemia found by MPI, and 9% in patients with significant diameter stenosis vs. 16% in patients with no diameter stenosis diagnosed by CAG. Conclusion NSAID use after both non-invasive diagnostic procedures and invasive CAG for diagnosing CAD decreased substantially over the study period. Despite NSAID use being lower in patients with a higher degree of CAD, it remained relatively high in patients with manifest CAD. Figure 1. Temporal trends in the 1-year prevalence of non-steroidal anti-inflammatory drug use by degree of coronary artery disease identified by coronary computed tomography angiography, myocardial perfusion imaging, and coronary angiograms.Figure 1