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Aspirin loading and coronary no-reflow after percutaneous coronary intervention in patients with acute myocardial
Gjin Ndrepepa1, Salvatore Cassese1, Erion Xhepa1
1Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Insights
Aspirin loading before percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients was linked to a higher risk of coronary no-reflow (CNR). Further research is needed to confirm these findings due to the limited number of events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Coronary no-reflow (CNR) is a complication following percutaneous coronary intervention (PCI).
- The impact of aspirin loading on CNR risk in acute myocardial infarction (AMI) patients is not well-established.
- This study investigates the association between pre-PCI aspirin loading and CNR in AMI patients.
Purpose of the Study:
- To assess the association between aspirin loading before PCI and the incidence of CNR.
- To determine if aspirin loading increases the risk of CNR in patients with AMI undergoing PCI.
Main Methods:
- A cohort of 3100 patients with AMI undergoing PCI was analyzed.
- 2812 patients received aspirin loading (150-300 mg oral or IV) before PCI.
- CNR was defined as Thrombolysis in Myocardial Infarction blood flow grade <3 post-PCI.
Main Results:
- Aspirin loading was associated with a significantly higher odds of CNR (OR=4.50, p=0.005), persisting after adjustment (aOR=4.49, p<0.001).
- The incidence of CNR was 4.5% in the aspirin loading group versus 1.0% in the no-loading group.
- No significant interaction was found between aspirin loading and P2Y12 inhibitors or chronic aspirin therapy regarding CNR risk.
Conclusions:
- Aspirin loading before PCI in AMI patients may be associated with an increased risk of developing CNR.
- The observed association suggests a potential, though not definitive, link between aspirin loading and CNR.
- Findings are considered hypothesis-generating due to a limited number of CNR events.
Background:
The association of aspirin loading with the risk of coronary no-reflow (CNR) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has not been investigated. We assessed the association of aspirin loading before PCI with CNR in patients with AMI.
Materials And Methods:
This study included 3100 patients with AMI undergoing PCI. Of them, 2812 patients received aspirin loading (a single oral [or chewed] or intravenous dose of 150-300 mg) and 288 patients did not receive aspirin loading before PCI. The primary endpoint was CNR, defined as Thrombolysis in Myocardial Infarction blood flow grade of <3 after the PCI.
Results:
CNR occurred in 130 patients: 127 patients in the group with aspirin loading and 3 patients in the group without aspirin loading before PCI (4.5% vs. 1.0%; odds ratio [OR] = 4.50, 95% confidence interval, [1.42-14.21], p = 0.005). After adjustment, the association between aspirin loading and CNR was significant (adjusted OR = 4.49 [1.56-12.92]; p < 0.001). There was no aspirin loading-by-P2Y12 inhibitor (ticagrelor or prasugrel) interaction (pint = 0.465) or aspirin loading-by-chronic aspirin therapy on admission (pint = 0.977) interaction with respect to the occurrence of CNR after PCI. Chronic low-dose aspirin therapy on admission was not independently associated with higher risk of CNR after PCI (adjusted OR = 1.06 [0.65-1.72]; p = 0.824).
Conclusion:
In patients with AMI undergoing PCI, aspirin loading before the PCI procedure at the guideline-recommended doses was associated with higher odds of developing CNR. However, due to the limited number of events, the findings should be considered as hypothesis generating.
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