Prior aspirin use a marker for recurrent events post-ACS, but not mortality
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Prior aspirin use was associated with more comorbidities and coronary disease and a higher risk of recurrent myocardial infarction (MI), but not mortality, after acute coronary syndrome (ACS).
Researchers evaluated 66,443 ACS patients from a merged database of 16 prospective, multicenter, randomized, placebo-controlled trials from the Thrombolysis in Myocardial Infarction trials. They evaluated the differences in ACS type, total mortality, and the composite end point of death, MI, recurrent ischemia, or stroke between prior aspirin and nonprior aspirin users. They reported results in the October 19 issue of the Journal of the American College of Cardiology.
Among the study population, 17,839 (26.8%) were identified as prior aspirin users. They were on average 3.5 years older (63 vs. 59) and had more coronary risk factors, such as diabetes, hypertension, hyperlipidemia and family history, and more evidence of coronary artery disease than non-aspirin users (all P<0.0001). Prior aspirin users were also more likely than non-aspirin users to take other cardiovascular medications before presenting with ACS.
Multivariate analysis found prior aspirin use was an independent predictor of less severe ACS at presentation (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.54-0.64 for STEMI vs. UA/NSTEMI and OR: 0.57; 95% CI: 0.52 to 0.63 for NSTEMI vs. UA).
There was no difference in total mortality between prior aspirin users and non-aspirin users at day 30 (OR: 1.01; 95% CI: 0.90-1.13) or by the last follow-up visit (mean 328 days) (hazard ratio: 1.03; 95% CI: 0.95-1.11). Prior aspirin use was modestly associated with recurrent MI (OR: 1.26; 95% CI: 1.12-1.43) and the composite end point of death, MI, recurrent ischemia or stroke (OR: 1.16; 95% CI: 1.08-1.24).
The authors wrote, “After adjustment for baseline characteristics, prior aspirin use did predict recurrent MI and ischemic events, but was not an independent predictor of total mortality after an ACS. As such, prior aspirin use should best be considered a marker of a patient population at high risk for recurrent adverse events after ACS.”