Cardiovasc Prev Pharmacother.  2019 Jul;1(1):30-42. 10.36011/cpp.2019.1.e4.

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

• Lee KY
• Shin DI
• Her SH
• Han SH
• Ahn Y
• Kim DS
• Choi DJ
• Kwon HM
• Gwon HC
• Rha SW
• Jo SH
• Lim SC
• Myong JP
• Baek SH

• KMID: 2536961
• DOI: http://doi.org/10.36011/cpp.2019.1.e4

Abstract

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.

Keyword

Angina pectoris; Angina pectoris, variant; Aspirin; Coronary vasospasm; Ergonovine

Figure

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  Figure 1. Flow chart of study population.VA = vasospastic angina.

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  Figure 2. Kaplan-Meier incidence curves of outcomes in 514 propensity-matched pairs in the positive and intermediate vasospastic angina groups. Long-term incidences in the 2 groups are presented as percentages and were statistically compared with the log-rank test. (A) Incidences of composite major adverse cardiac event, (B) Incidences of cardiac death, (C) Incidences of arrhythmia, (D) Incidences of acute coronary syndrome.ACS = acute coronary syndrome.

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  Figure 3. HR for aspirin vs. control group and event rates for the primary composite outcome among propensity-matched patient. CAG = coronary angiogram; CI = confidence interval; HR = hazard ratio; LAS = low dose aspirin; LDL-C = Low-density lipoprotein Cholesterol; LVEF = left ventricle ejection fraction.*HRs are for the LAS group, as compared control group.

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