Association of Discharge Aspirin Dose With Outcomes After Acute Myocardial Infarction: Insights From the Treatment
Ying Xian1, Tracy Y Wang2, Lisa A McCoy2
1From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (Y.X., T.Y.W., L.A.M., E.D.P.); Lilly USA LLC, Indianapolis, IN (M.B.E., M.E.Z.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Washington University School of Medicine, St. Louis, MO (R.G.B.); Daiichi Sankyo Inc, Parsippany, NJ (B.A.B.); and UCLA Medical Center, Los Angeles, CA (G.C.F.). ying.xian@duke.edu.
Circulation
|May 22, 2015
Summary
High-dose aspirin (325 mg) after stenting did not reduce major adverse cardiovascular events compared to low-dose aspirin (81 mg). However, high-dose aspirin increased the risk of minor bleeding events in myocardial infarction patients.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Aspirin is a cornerstone antiplatelet therapy following myocardial infarction.
- Optimal maintenance dosage of aspirin post-percutaneous coronary intervention (PCI) with stenting remains an area of clinical uncertainty.
Purpose of the Study:
- To compare the efficacy and safety of high-dose (325 mg) versus low-dose (81 mg) aspirin maintenance therapy.
- To evaluate major adverse cardiovascular events (MACE) and bleeding risk in patients with myocardial infarction undergoing PCI.
Main Methods:
- Retrospective analysis of 10,213 patients from the TRANSLATE-ACS study (2010-2012).
- Comparison of outcomes between high-dose and low-dose aspirin groups using propensity score adjustment.
- Assessment of MACE and Bleeding Academic Research Consortium (BARC) defined bleeding events within 6 months postdischarge.
Main Results:
- No significant difference in the risk of major adverse cardiovascular events between high-dose and low-dose aspirin groups (aHR, 0.99; 95% CI, 0.85-1.17).
- High-dose aspirin was associated with a significantly greater risk of any BARC-defined bleeding events (aOR, 1.19; 95% CI, 1.06-1.33).
- The increased bleeding risk with high-dose aspirin was primarily driven by minor (BARC type 1 or 2) bleeding events, with no significant difference in hospitalization-requiring bleeding.
Conclusions:
- In PCI-treated myocardial infarction patients, high-maintenance-dose aspirin offers no significant cardiovascular benefit over low-dose aspirin.
- High-dose aspirin is associated with an increased risk of minor bleeding events compared to low-dose aspirin in this patient population.
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