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Orthotopic Aortic Transplantation: A Rat Model to Study the Development of Chronic Vasculopathy
Published on: December 4, 2010
Association of Aspirin Treatment With Cardiac Allograft Vasculopathy Progression and Adverse Outcomes After Heart
Rabea Asleh1, Alexandros Briasoulis2, Byron Smith3
1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Heart Institute, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University, Jerusalem 90000, Israel.
Insights
Early aspirin (ASA) use after heart transplantation (HT) significantly reduced cardiac allograft vasculopathy (CAV) progression and mortality. However, it did not impact the overall composite of CAV-related events.
Area of Science:
- Cardiology
- Immunology
- Transplantation Medicine
Background:
- Platelet reactivity is implicated in cardiac allograft vasculopathy (CAV) progression.
- The role of antiplatelet agents, specifically aspirin (ASA), after heart transplantation (HT) remains unclear due to inconsistent use and limited evidence.
Purpose of the Study:
- To investigate the impact of early aspirin (ASA) use on the progression of cardiac allograft vasculopathy (CAV) after heart transplantation (HT).
- To evaluate the effect of early ASA on mortality and CAV-related events in HT recipients.
Main Methods:
- Retrospective analysis of 529 heart transplant recipients.
- Coronary intravascular ultrasound was used to assess plaque volume and index changes over time.
- Comparison of outcomes between patients receiving early ASA (within 1 year post-HT) versus late or no ASA.
Main Results:
- Early ASA treatment significantly attenuated the progression of plaque volume (P=.007) and plaque index (P=.002).
- All-cause mortality was significantly lower in the early ASA group over a 6.7-year follow-up (P<.001).
- The early ASA group showed no cardiac deaths and a significantly lower risk of CAV-related graft dysfunction (P=.03).
Conclusions:
- Early initiation of aspirin (ASA) after heart transplantation (HT) may effectively delay cardiac allograft vasculopathy (CAV) progression.
- Early ASA use is associated with reduced mortality and CAV-related graft dysfunction.
- While early ASA benefits specific outcomes, it did not significantly alter the composite of all CAV-related events.
Background:
Enhanced platelet reactivity may play a role in cardiac allograft vasculopathy (CAV) progression. The use of antiplatelet agents after heart transplantation (HT) has been inconsistent and although aspirin (ASA) is often a part of the medication regimen after HT, limited evidence is available on its benefit.
Methods And Results:
CAV progression was assessed by measuring the difference in plaque volume and plaque index between the last follow-up and the baseline coronary intravascular ultrasound examination. Overall, 529 HT recipients were retrospectively analyzed (337 had ≥2 intravascular ultrasound studies). The progression in plaque volume (P = .007) and plaque index (P = .002) was significantly attenuated among patients treated with early ASA (within the first year after HT). Over a 6.7-year follow-up, all-cause mortality was lower with early ASA compared with late or no ASA use (P < .001). No cardiac deaths were observed in the early ASA group, and the risk of CAV-related graft dysfunction was significantly lower in this group (P = .03). However, the composite of all CAV-related events (cardiac death, CAV-related graft dysfunction, or coronary angioplasty) was not significantly different between the groups (P = .16).
Conclusions:
Early ASA use after HT may delay CAV progression and decrease mortality and CAV-related graft dysfunction, but does not seem to affect overall CAV-associated events.
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