The clinical outcomes of percutaneous coronary intervention performed without pre-procedural aspirin

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Pharmacotherapy

Background:

• Aspirin is a critical medication for patients undergoing percutaneous coronary intervention (PCI).
• Previous research indicates that a notable percentage of patients do not receive aspirin prior to PCI.
• This gap in peri-procedural care warrants investigation into its impact on patient outcomes.

Purpose of the Study:

• To determine the incidence of PCI procedures performed without pre-procedural aspirin administration.
• To analyze the clinical outcomes associated with the absence of aspirin before PCI.
• To identify patient characteristics associated with non-receipt of aspirin before PCI.

Main Methods:

• Retrospective analysis of 65,175 patients undergoing PCI across 44 Michigan hospitals (January 2010 - December 2011).
• Evaluation of aspirin administration within 24 hours prior to PCI.
• Propensity-matched multivariate analysis to control for confounding variables and assess outcomes.

Main Results:

• 7.1% of patients (4,640) did not receive aspirin before PCI.
• Aspirin non-recipients were more likely to have a history of gastrointestinal bleeding, cardiogenic shock, or cardiac arrest.
• Absence of pre-PCI aspirin was associated with significantly higher in-hospital mortality (3.9% vs. 2.8%) and stroke rates (0.5% vs. 0.1%) in propensity-matched analysis.

Conclusions:

• A substantial proportion of patients undergoing PCI do not receive aspirin pre-procedure.
• Lack of pre-procedural aspirin is significantly associated with increased in-hospital mortality and stroke.
• These findings underscore the importance of quality improvement initiatives to optimize aspirin use before PCI.