Patients Who Do Not Receive Aspirin Before PCI Have Greater Risk of Mortality and Stroke

A large registry in Michigan found that 7.1 percent of patients did not receive aspirin within 24 hours before undergoing a percutaneous coronary intervention (PCI) – and the risk of in-hospital mortality and stroke is significantly greater than those who receive aspirin within 24 hours pre-PCI, according to the results of a large study of registry data published Oct. 2 in the Journal of the American College of Cardiology .

"What we've seen from this very large study is that patients who failed to receive aspirin before their PCI had a significant increase in both death and stroke while in-hospital," said Herbert Aronow, MD, FACC.

The study's investigators evaluated outcome data from the Blue Cross-Blue Shield of Michigan Cardiovascular Consortium registry of 65,175 patients who underwent PCI between 2010 and 2011 at 44 hospitals in Michigan. Investigators compared results among people who received aspirin and the 4,640 (7.1 percent) who did not receive aspirin within 24 hours of the procedure.

In a propensity-matched analysis, the researchers found that 3.9 percent of patients who did not receive aspirin pre-PCI died in the hospital versus 2.8 percent of those who received aspirin pre-procedure (p < 0.001), and 0.5 percent of the non-aspirin cohort had a stroke versus 0.1 percent of the aspirin cohort of patients (p = 0.007).

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Among the patients who received aspirin, only 495 (10.7 percent) had documented contraindications to aspirin use. Prior PCI was more common among those who received aspirin, and prior gastrointestinal bleeding was more common among those who did not receive aspirin. There was a trend toward an increased risk of CABG that was not statistically significant, and there was no significant difference between the two groups of patients in the need for transfusion, post-PCI MI, repeat PCI to the same lesion, vascular complications or other adverse outcomes.

"The key finding of our study is that a significant number of patients do not receive aspirin prior to undergoing PCI despite the Class 1 recommendations for pre-procedural aspirin in both the ACC/American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines for PCI," wrote the study authors. They note that moving forward, "further studies are needed to confirm our findings and motivate quality efforts focused on optimizing aspirin use prior to PCI, as recommended by ACC/AHA and ESC guidelines for PCI."

Keywords: Registries, Myocardial Infarction, Michigan, Stroke, Hospital Mortality, Blue Cross Blue Shield Insurance Plans, Percutaneous Coronary Intervention

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