Nine RCTs, four cohort studies and two nested case-control studies were included in the review. RCT sample sizes ranged from 1,561 to 34,701 and follow-up ranged from six months to three years. No sample sizes and study durations were reported for observational studies.
Six observational studies reported that NSAID therapy in comparison with control was associated with a statistically significant increase in non-fatal myocardial infarction (RR 1.30, 95% CI 1.20 to 1.41), but no significant difference in fatal myocardial infarction (RR 1.02, 95% CI 0.89 to 1.17).
The nine RCTs reported that coxibs (selective NSAIDs), compared with either traditional NSAIDs (four trials) or placebo (five trials), were associated with an increase in non-fatal myocardial infarction (RR 1.61, 95% CI 1.04 to 2.50), but no significant difference in fatal myocardial infarctions (RR 0.86, 95% CI 0.51 to 1.47).
Overall risk increase for non-fatal myocardial infarction was 25% higher (95% CI 11% to 42%) than for fatal myocardial infarction. The two cohort studies that included only individuals with prior cardiovascular disease presented risk estimates for nonfatal myocardial infarction on average 58% greater (95% CI 26% to 98%) than those for fatal myocardial infarction.