In the Journals

Absence of aspirin before PCI associated with increased mortality, stroke

Patients who do not receive aspirin prior to PCI are at an increased risk for in-hospital mortality and stroke compared with patients administered aspirin within 24 hours of undergoing the procedure, according to findings published in the Journal of American College of Cardiology.

Researchers of the study examined outcomes of 65,175 patients undergoing PCI between January 2010 and December 2011at 44 hospitals enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) registry.

Overall, 4,640 (7.1%) patients did not receive pre-procedural aspirin within 24 hours of undergoing PCI. Researchers adjusted for the non-random use of aspirin by using propensity matched multivariate analysis.

A higher rate of in-hospital mortality was found in patients who were not prescribed aspirin prior to undergoing PCI (3.9% vs. 2.8%; P=.005), as was a higher rate of stroke (0.5% vs. 0.1%; P=.007). There was no difference in need for transfusions among patients.

These associations were consistent across multiple pre-specified subgroups.

“A significant number of patients do not receive aspirin prior to undergoing PCI,” the researchers wrote. “Our study results support the need for quality efforts focused on optimizing aspirin use prior to PCI.”

However, the researchers added that the data should be considered hypothesis generating.

“Triggered by our findings, similar studies to further test our hypothesis as well as others to analyze the long-term outcomes associated with aspirin non-use before and following PCI should be considered,” they wrote. “If our results are replicated, this would justify more focused efforts to optimize aspirin use and shape a strategy to manage patients with true contraindications or intolerances to aspirin therapy including the need for desensitization therapy, consideration of other options for dual antiplatelet therapy or possible surgical revascularization, which would not require aspirin pre-treatment.”

Disclosure: One researcher reports being employed by Blue Cross Blue Shield of Michigan. None of the other researchers report relevant financial disclosures.

Patients who do not receive aspirin prior to PCI are at an increased risk for in-hospital mortality and stroke compared with patients administered aspirin within 24 hours of undergoing the procedure, according to findings published in the Journal of American College of Cardiology.

Researchers of the study examined outcomes of 65,175 patients undergoing PCI between January 2010 and December 2011at 44 hospitals enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) registry.

Overall, 4,640 (7.1%) patients did not receive pre-procedural aspirin within 24 hours of undergoing PCI. Researchers adjusted for the non-random use of aspirin by using propensity matched multivariate analysis.

A higher rate of in-hospital mortality was found in patients who were not prescribed aspirin prior to undergoing PCI (3.9% vs. 2.8%; P=.005), as was a higher rate of stroke (0.5% vs. 0.1%; P=.007). There was no difference in need for transfusions among patients.

These associations were consistent across multiple pre-specified subgroups.

“A significant number of patients do not receive aspirin prior to undergoing PCI,” the researchers wrote. “Our study results support the need for quality efforts focused on optimizing aspirin use prior to PCI.”

However, the researchers added that the data should be considered hypothesis generating.

“Triggered by our findings, similar studies to further test our hypothesis as well as others to analyze the long-term outcomes associated with aspirin non-use before and following PCI should be considered,” they wrote. “If our results are replicated, this would justify more focused efforts to optimize aspirin use and shape a strategy to manage patients with true contraindications or intolerances to aspirin therapy including the need for desensitization therapy, consideration of other options for dual antiplatelet therapy or possible surgical revascularization, which would not require aspirin pre-treatment.”

Disclosure: One researcher reports being employed by Blue Cross Blue Shield of Michigan. None of the other researchers report relevant financial disclosures.