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The Clinical Outcomes of Percutaneous Coronary Intervention Performed Without Pre-Procedural Aspirin
Study Questions:
What are the incidence and outcomes of percutaneous coronary intervention (PCI) performed in patients who had not received preprocedural aspirin?
Methods:
The investigators evaluated the incidence of PCIs performed without preprocedural aspirin use among patients undergoing PCI from January 2010 through December 2011, at 44 hospitals in Michigan. Propensity-matched multivariate analysis was used to adjust for the nonrandom use of aspirin.
Results:
The study population was comprised of 65,175 patients, of whom 4,640 (7.1%) did not receive aspirin within 24 hours prior to undergoing PCI. Aspirin nonreceivers were more likely to have had prior gastrointestinal bleeding or to present with cardiogenic shock or following cardiac arrest. In the propensity-matched analysis, absence of aspirin prior to PCI was associated with a higher rate of death (3.9% vs. 2.8%; odds ratio [OR], 1.89; 95% confidence interval [CI], 1.32-2.71; p = 0.005) and stroke (0.5% vs. 0.1%; OR, 4.24; 95% CI, 1.49-12.11; p = 0.007) with no difference in need for transfusions. This association was consistent across multiple prespecified subgroups.
Conclusions:
The authors concluded that a significant number of patients do not receive aspirin prior to undergoing PCI, and lack of aspirin prior to PCI was associated with significantly increased in-hospital mortality and stroke.
Perspective:
This study reported that a significant number of patients do not receive aspirin prior to undergoing PCI despite the Class I recommendations for preprocedural aspirin in both the US and European guidelines. Furthermore, absence of aspirin prior to PCI appears to be associated with an increased risk of mortality and stroke. If these results are validated, this would justify focused efforts to optimize aspirin use and develop strategies to manage patients with true contraindications or intolerances to aspirin therapy including the need for desensitization therapy prior to elective PCI, and consideration of other options for dual antiplatelet therapy.
Keywords: Michigan, Stroke, Multivariate Analysis, Hospital Mortality, Platelet Aggregation Inhibitors, Shock, Gastrointestinal Hemorrhage, Percutaneous Coronary Intervention
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