Impact of aspirin on the prognosis in patients with coronary spasm without significant atherosclerotic stenosis.

Abstract

BACKGROUND:

Coronary spasm is one of the mechanisms of myocardial infarction with nonobstructive coronary arteries (MINOCA). The aim of this study was to investigate the effects of aspirin on future cardiovascular events in patients with coronary vasospastic angina (VSA) with non-significant atherosclerotic stenosis.

METHODS:

This was the retrospective analysis of the 640 VSA patients with non-significant atherosclerotic stenosis (≤50% stenosis) among 1,877 consecutive patients who underwent acetylcholine (ACh)-provocation testing between January 1991 and December 2010. The patients were divided into 2 groups treated with (n=137) or without (n=503) low-dose aspirin (81-100mg/day). We evaluated major adverse cardiac events (MACE), defined as cardiac death, nonfatal myocardial infarction, and unstable angina.

RESULTS:

In the study population, 24 patients (3.8%) experienced MACE; there were 6 cases in VSA patients with aspirin and 6 in those without aspirin. Multivariate Cox hazards analysis for correlated factors of MACE indicated that use of statin (HR: 0.11; 95% CI: 0.02 to 0.84; P=0.033), ST-segment elevation during attack (HR: 5.28; 95% CI: 2.19-12.7; P<0.001), but not the use of aspirin as a significant predictor of MACE. After propensity score matching (n=112, each), Kaplan-Meier survival analysis indicated almost identical rate of 5-year survival free from MACE in those with aspirin, compared to those without aspirin in the entire and matched cohort (P=0.640 and P=0.541, respectively).

CONCLUSIONS:

Low-dose aspirin might not reduce future cardiovascular events in VSA patients with non-significant stenosis.

• Authors: Masanobu Ishii, Koichi Kaikita, Koji Sato, Kenshi Yamanaga, Takashi Miyazaki, Tomonori Akasaka, Noriaki Tabata, Yuichiro Arima, Daisuke Sueta, Kenji Sakamoto, Eiichiro Yamamoto, Kenichi Tsujita, Megumi Yamamuro, Sunao Kojima, Hirofumi Soejima, Seiji Hokimoto, Kunihiko Matsui, Hisao Ogawa
• Journal: International journal of cardiology (Int J Cardiol) Vol. 220 Pg. 328-32 (Oct 01 2016) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 27390950 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Platelet Aggregation Inhibitors
• Aspirin

Topics

• Aged
• Aspirin (administration & dosage)
• Cohort Studies
• Coronary Artery Disease (diagnosis, drug therapy, mortality)
• Coronary Vasospasm (diagnosis, drug therapy, mortality)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, mortality, prevention & control)
• Platelet Aggregation Inhibitors (administration & dosage)
• Prognosis
• Retrospective Studies
• Survival Rate (trends)