Despite recommendations from leading medical groups, a surprising number of patients are not given aspirin before artery-clearing coronary angioplasty and stenting, and those patients have a significantly higher in-hospital death rate, according to research from a Michigan network being presented at the American College of Cardiology's 62nd Annual Scientific Session.
Aspirin use before angioplasty is a Class I recommendation of the American College of Cardiology and American Heart Association, the highest level of evidence for ACC/AHA guidelines. Aspirin has well-documented anti-platelet activity in reducing the risk of cardiac events.
Researchers evaluated registry data for 65,175 patients who had angioplasty and stenting, a percutaneous coronary intervention or PCI, at one of 42 hospitals enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI Quality Improvement Initiative from January 2010 through December 2011. Of these, 4,640 patients, or 7.1 percent, did not receive aspirin as recommended within 24 hours before PCI. Roughly 90 percent of the non-aspirin patients had no documented barriers to aspirin. Records did show that aspirin was withheld from some patients who had a history of gastrointestinal bleeding, even though such a history usually does not preclude pre-PCI aspirin.
"Our study is not designed to confirm a direct causal effect of aspirin use on PCI outcomes, but [rather] to examine any association with worse outcomes," said Mohamad Kenaan, MD, a cardiovascular medicine fellow with University of Michigan Health Systems, Ann Arbor, Mich., and the study's lead investigator. "Moreover, it highlights an unexpectedly significant number of patients undergoing PCI without receiving aspirin, despite the lack of a documented contraindication in the majority of cases-even in institutions that are active participants in an ongoing quality improvement initiative."