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Association between Aspirin Therapy and Clinical Outcomes in Patients with Non-Obstructive Coronary Artery Disease: A
In-Chang Hwang1, Joo-Yeong Jeon2, Younhee Kim3
1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
Insights
Aspirin use in non-obstructive coronary artery disease (CAD) patients is linked to reduced all-cause mortality, particularly in older individuals and those with higher risk factors. This benefit was not observed for the composite endpoint of mortality and revascularization.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Non-obstructive coronary artery disease (CAD) is often treated with preventive medications like aspirin.
- The impact of aspirin on mortality and revascularization in this specific patient group remains under-investigated.
Purpose of the Study:
- To investigate the association between aspirin therapy and all-cause mortality and coronary revascularization in patients with non-obstructive CAD.
- To identify subgroups of patients with non-obstructive CAD who may benefit from aspirin therapy.
Main Methods:
- Retrospective analysis of 8372 patients with non-obstructive CAD (1-49% stenosis) identified via coronary computed tomography angiography (CCTA).
- Exclusion of patients with prior statin/aspirin use or revascularization.
- Comparison of all-cause mortality and a composite endpoint (mortality and late revascularization) between aspirin users and non-users.
Main Results:
- Aspirin therapy was associated with a significantly lower risk of all-cause mortality (adjusted HR 0.649; p=0.0023).
- No significant association was found between aspirin and the composite endpoint (adjusted HR 0.841; p=0.1577).
- The mortality benefit of aspirin was concentrated in patients aged ≥65 years, with diabetes, hypertension, reduced renal function, and elevated risk markers (CAC, LDL-C, hs-CRP).
Conclusions:
- Aspirin is associated with reduced all-cause mortality in patients with non-obstructive CAD, but this benefit is confined to higher-risk individuals.
- The findings suggest a personalized approach to aspirin therapy in non-obstructive CAD based on patient risk stratification.
Background:
Presence of non-obstructive coronary artery disease (CAD) is associated with increased prescription of cardiovascular preventive medications including aspirin. However, the association between aspirin therapy with all-cause mortality and coronary revascularization in this population has not been investigated.
Methods And Findings:
Among the cohort of individuals who underwent coronary computed tomography angiography (CCTA) from 2007 to 2011, 8372 consecutive patients with non-obstructive CAD (1-49% stenosis) were identified. Patients with statin or aspirin prescription before CCTA, and those with history of revascularization before CCTA were excluded. We analyzed the differences of all-cause mortality and a composite of mortality and late coronary revascularization (> 90 days after CCTA) between aspirin users (n = 3751; 44.8%) and non-users. During a median of 828 (interquartile range 385-1,342) days of follow-up, 221 (2.6%) mortality cases and 295 (3.5%) cases of composite endpoint were observed. Annualized mortality rates were 0.97% in aspirin users versus 1.28% in non-users, and annualized rates of composite endpoint were 1.56% versus 1.48%, respectively. Aspirin therapy was associated with significantly lower risk of all-cause mortality (adjusted HR 0.649; 95% CI 0.492-0.857; p = 0.0023), but not with the composite endpoint (adjusted HR 0.841; 95% CI 0.662-1.069; p = 0.1577). Association between aspirin and lower all-cause mortality was limited to patients with age ≥ 65 years, diabetes, hypertension, decreased renal function, and higher levels of coronary artery calcium score, low-density lipoprotein cholesterol and high-sensitivity C-reactive protein.
Conclusions:
Among the patients with non-obstructive CAD documented by CCTA, aspirin is associated with lower all-cause mortality only in those with higher risk.
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