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Published on: March 15, 2022
Aspirin and Clinical Outcomes in Individuals with Incidentally Diagnosed Coronary Artery Stenosis
In Tae Jin1, Yangyoun Lee2, Eui-Young Choi3
1Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea.
Insights
Aspirin provided no significant benefit for preventing cardiovascular events or bleeding in asymptomatic individuals with coronary stenosis. Personalized aspirin use is recommended over universal prescription for this patient group.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Coronary computed tomographic angiography (CCTA) increasingly identifies coronary stenosis in asymptomatic individuals.
- Current guidelines recommend aspirin for secondary cardiovascular prevention, but its benefit in this specific population is unclear.
Purpose of the Study:
- To evaluate the net clinical benefit of aspirin in asymptomatic individuals with incidentally diagnosed coronary stenosis.
- To determine if aspirin reduces major adverse cardiovascular events (MACE) or increases bleeding risk in this cohort.
Main Methods:
- A propensity score-matched study analyzed 636 asymptomatic individuals with coronary stenosis (318 aspirin users, 318 controls).
- Participants underwent CCTA between 2007 and 2022.
- The primary outcome was a composite of cardiovascular death, myocardial infarction, ischemic stroke/transient ischemic attack, with or without major bleeding.
Main Results:
- No significant difference in composite cardiovascular events was observed between aspirin and control groups (HR 0.62, P = .20).
- Aspirin use was associated with a higher risk of major bleeding (HR 1.16, P = .60).
- Kaplan-Meier analysis showed no significant difference in composite events with or without major bleeding between groups.
Conclusions:
- Aspirin does not demonstrate a benefit for composite cardiovascular events or bleeding in asymptomatic individuals with coronary stenosis.
- Personalized aspirin therapy, considering individual risk factors, is suggested instead of a universal approach for this population.
Background:
The widespread use of coronary computed tomographic angiography has increased the number of cases of coronary stenosis in asymptomatic individuals. In this population, we aimed to analyze the net benefit of aspirin, which is currently recommended for secondary cardiovascular prevention.
Methods:
This propensity score-matching study screened 41,441 asymptomatic individuals who underwent coronary computed tomographic angiography during health checkups between 2007 and 2022. Ultimately, 1483 patients with incidentally diagnosed coronary stenosis were enrolled after excluding ineligible individuals. Using a 1:1 propensity score matching, data from 636 individuals (318 new aspirin users and 318 controls) were analyzed. The primary outcome variable was composite cardiovascular events (cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke/transient ischemic attack), with/without major bleeding.
Results:
At a median follow-up of 6.3 years, 11 and 18 individuals experienced composite events in the aspirin and control groups (2.1 and 3.2/1000 person-years; hazard ratio 0.62; P = .20), respectively. Conversely, composite events and major bleeding occurred in 26 and 23 individuals in the aspirin and control groups (4.9 and 4.1/1000 person-years; hazard ratio 1.16; P = .60), with a higher bleeding risk in the aspirin group. Kaplan-Meier curves demonstrated no significant difference in composite events without (log-rank P = .21) or with major bleeding (P = .61). Furthermore, age, chronic kidney disease, and low high-density lipoprotein cholesterol were identified as predictors of composite events and bleeding.
Conclusions:
Aspirin showed no benefit for composite events and bleeding in asymptomatic individuals with coronary stenosis. Thus, personalized aspirin use rather than universal aspirin use may be more appropriate for this population.
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