Clinical implications of low-dose aspirin on vasospastic angina patients without significant coronary artery stenosis; a propensity score-matched analysis

Lim, Amareth; Park, Taek Kyu; Cho, Sung Woo; Oh, Min Seok; Lee, Da Hyon; Seong, Choong Sil; Gwag, Hye Bin; Yang, Jeong Hoon; Song, Young Bin; Hahn, Joo‐Yong; Choi, Jin‐Ho; Lee, Sang Hoon; Gwon, Hyeon‐Cheol; Ahn, Joonghyun; Carrière, Keumhee C.; Choi, Seung–Hyuk

doi:10.1016/j.ijcard.2016.06.195

Cited by 23 publications

(27 citation statements)

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“…There exist data from in-vitro and in-vivo studies supporting this concept, but clinical data regarding the use of aspirin in VA are scarce, other than from small observational studies or case reports 2,4,5 . A recent large study has reported aspirin use causing adverse effects in VA patients even at small doses 6 . However, until now there have been no subsequent studies showing adverse effects of aspirin in VA patients.…”

Section: Introductionmentioning

confidence: 99%

Clopidogrel plus Aspirin Use is Associated with Worse Long-Term Outcomes, but Aspirin Use Alone is Safe in Patients with Vasospastic Angina: Results from the VA-Korea Registry, A Prospective Multi-Center Cohort

Cho

Han

et al. 2019

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Anti-platelet agents are commonly used in vasospastic angina (VA) patients with comorbidity like coronary artery disease. However, long-term clinical outcomes in the use of aspirin, clopidogrel or the two agents together have rarely been investigated in VA patients. In a prospective study, we enrolled 2960 patients who received coronary angiography and ergonovine provocation test at 11 university hospitals in Korea. Among them, 1838 patients were diagnosed either with definite (n = 680) or intermediate (n = 1212) VA, using the criteria of chest pain, ECG changes and ergonovine provocation test results. They were analyzed according to their use of aspirin, clopidogrel or both, or no anti-platelet agent at all. The primary outcome was time to composite events of death from any cause, acute coronary syndrome (ACS) and symptomatic arrhythmia during a 3-year follow-up. A primary composite outcome was significantly more common in the aspirin plus clopidogrel group, at 10.8% (14/130), as compared with the non-antiplatelet group, at 4.4% (44/1011), (hazard ratio [HR] 2.41, 95% confidence interval [CI], 1.32–4.40, p = 0.004). With regard to the person-time event rate, similar results were shown, with the highest rate in the aspirin plus clopidogrel user at 4.72/1000 person months (95% CI, 2.79–7.96, log-rank test for primary outcome p = 0.016). The person-time event of the ACS rate was also highest in that group, at 2.81 (95% CI, 1.46–5.40, log-rank test for ACS p = 0.116). Kaplan-Meier survival analysis demonstrated poor prognosis in primary outcomes and ACS in aspirin plus clopidogrel users (log-rank test, p = 0.005 and p = 0.0392, respectively). Cox-proportional hazard regression analysis, adjusting for age, sex, history of coronary heart disease, hypertension, diabetes, presence or not of definite spasm, use of calcium channel blocker, demonstrated that the use of aspirin plus clopidogrel is an independent risk for the primary outcome (HR 2.01, CI: 1.07–3.81, p = 0.031). The aspirin-alone group had a similar primary and individual event rate compared to the no-antiplatelet agent group (HR 0.96, CI, 0.59–1.55, p = 0.872). Smokers using aspirin plus clopidogrel had poorer outcomes than non-smokers, with HR 6.36 (CI 2.31–17.54, p = 0.045 for interaction). In conclusion, among VA patients, aspirin plus clopidogrel use is associated with a poor clinical outcome at 3 years, especially in ACS. Aspirin alone appears to be safe for use in those patients.

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Section: Introductionmentioning

confidence: 99%

Clopidogrel plus Aspirin Use is Associated with Worse Long-Term Outcomes, but Aspirin Use Alone is Safe in Patients with Vasospastic Angina: Results from the VA-Korea Registry, A Prospective Multi-Center Cohort

Cho

Han

et al. 2019

Sci Rep

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“…21) In contrast, Lim et al reported that those taking aspirin showed a higher tendency for recurrent angina contributing to rehospitalization. 14) In this study, the aspirin group had much minimal organic stenosis, which might result in a higher incidence of rehospitalization due to angina ( Table 3). In addition, both studies were limited by their single-center retrospective nature.…”

Section: Discussionmentioning

confidence: 66%

“…12) In contrast, other recent clinical studies have suggested that low-dose aspirin not only failed to reduce cardiovascular events but could also lead to recurrent angina, contributing to rehospitalization. [13][14][15] However, these studies have several limitations, such as being single-center retrospective observational studies or including relatively small populations.…”

Section: Introductionmentioning

confidence: 99%

Aspirin Has a Neutral Effect in Preventing Future Cardiovascular Events in Vasospastic Angina

Lee

Shin

Her

et al. 2019

Cardiovasc Prev Pharmacother

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Background: The aim of this multi-center prospective registry study was to evaluate the clinical efficacy of low-dose aspirin in vasospastic angina (VA) patients for the prevention of future cardiovascular events. Methods: A total of 1,717 patients with positive and intermediate results of an intracoronary ergonovine provocation test in the VA in Korea registry (n=2,960) were classified into 100 mg/day aspirin intake (aspirin, n=743) and no-aspirin intake (control, n=974) groups. The primary end-point was a composite of major adverse cardiac events (MACEs) including cardiac death, new-onset arrhythmia, and acute coronary syndrome. Results: The median follow-up duration was 2.0 years (25-75th, interquartile range 0.9-3.0 years). Cumulative composite MACE in the propensity score matched-pair cohort (n=1,028) was 3.6%. There was no significant difference in composite MACE between the aspirin and control groups (3.1% vs. 4.1%; hazard ratio [HR], 1.18; 95% confidence interval [CI], 0.61-2.26; p=0.623). A sensitivity analysis of only the VA-positive population showed these results to be consistent. Even for patients with minimal organic stenosis (n=369), aspirin usage was not related to the incidence of a composite MACE (HR, 1.61; 95% CI, 0.55-4.72; p=0.380). Conclusions: Low-dose aspirin does not protect against future cardiovascular events in VA patients, even patients who combine with minimal coronary artery stenosis.

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“…Moreover, they showed that an additional of cilostazol may be promising, although the finding that the CCB adopted in the present study was amlodipine, which was not the standard CCB for the prevention of coronary spasm in VSA patients, was a slightly controversial. The usefulness of other drugs such as statins[ 72 , 73 ] and a low-dose aspirin[ 74 , 75 ] on clinical outcomes has been accumulated, and these drugs may be considered to improve the clinical outcomes in VSA patients (Table 1 ).…”

Section: Treatment Of Coronay Spasmmentioning

confidence: 99%

Coronary spasm: It’s common, but it’s still unsolved

Teragawa¹,

Oshita²,

Ueda³

2018

WJC

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Coronary spasm is caused by a transient coronary narrowing due to the constriction of epicardial coronary artery, which leads to myocardial ischemia. More than 50 years have passed since the first recognition of coronary spasm, and many findings on coronary spasm have been reported. Coronary spasm has been considered as having pivotal roles in the cause of not only rest angina but also exertional angina, acute coronary syndrome, and heart failure. In addition, several new findings of the mechanism of coronary spasm have emerged recently. The diagnosis based mainly on coronary angiography and spasm provocation test and the mainstream treatment with a focus on a calcium-channel blocker have been established. At a glance, coronary spasm or vasospastic angina (VSA) has become a common disease. On the contrary, there are several uncertain or unsolved problems regarding coronary spasm, including the presence of medically refractory coronary spasm (intractable VSA), or an appropriate use of implantable cardioverter defibrillator in patients with cardiac arrest who have been confirmed as having coronary spasm. This editorial focused on coronary spasm, including recent topics and unsolved problems.

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Clinical implications of low-dose aspirin on vasospastic angina patients without significant coronary artery stenosis; a propensity score-matched analysis

Cited by 23 publications

References 20 publications

Clopidogrel plus Aspirin Use is Associated with Worse Long-Term Outcomes, but Aspirin Use Alone is Safe in Patients with Vasospastic Angina: Results from the VA-Korea Registry, A Prospective Multi-Center Cohort

Clopidogrel plus Aspirin Use is Associated with Worse Long-Term Outcomes, but Aspirin Use Alone is Safe in Patients with Vasospastic Angina: Results from the VA-Korea Registry, A Prospective Multi-Center Cohort

Aspirin Has a Neutral Effect in Preventing Future Cardiovascular Events in Vasospastic Angina

Coronary spasm: It’s common, but it’s still unsolved

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