Aspirin use did not reduce major adverse cardiovascular event risk across coronary calcium scores in smokers undergoing CCTA, with no significant bleeding risk difference.
Does aspirin reduce MACE in adults with suspected chronic coronary syndrome undergoing CCTA across different CACS categories and smoking statuses?
Aspirin for primary prevention does not reduce MACE risk across coronary calcium score categories in patients with suspected chronic coronary syndrome, regardless of smoking status.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background The effectiveness of aspirin (ASA) for primary prevention of major adverse cardiovascular events (MACE) in persons who smoke tobacco remains unclear, particularly among patients who underwent cardiac computed tomography angiography (CCTA) and coronary artery calcium scoring (CACS) due to suspected chronic coronary syndrome. Purpose To evaluate the risk of MACE and bleeding events across predefined CACS categories in relation to ASA use and smoking status. Methods A registry-based study of adult individuals (≥18 years of age) who underwent CCTA and CACS measurement from 2008-2022. Individuals were stratified by baseline ASA use (yes/no), CACS category (0, 1–99, 100–399, 400–999, ≥1000) and smoking status (current or prior versus no). Main exclusion criteria: history of acute coronary syndrome, coronary interventions, stroke, or treatment with ASA, anticoagulants, or P2Y12 inhibitors. The effectiveness endpoint was MACE, a composite of: death from any cause, non-fatal acute coronary syndrome, or non-fatal stroke, or revascularization. The safety endpoint was major bleeding requiring hospitalization. Follow-up began at 180 days after CCTA and ended upon event, emigration, death (for bleeding endpoint), or 2 years of follow-up, whichever came first. Absolute risks and risk differences (ASA vs no ASA) of the effectiveness and safety endpoints were computed using average treatment effect modelling with multivariable Cox regression analysis standardised to the distributions of age, sex and selected comorbidities. Results Of 65,519 included patients, 44.8% were non-smokers (25.7% used ASA), 55.2% were smokers (32.6% used ASA). Among non-smokers in lower CACS categories, no significant difference in the standardized absolute risk of MACE was observed between ASA users and non-users (all P for risk difference ≥0.05, Figure 1). ASA use was associated with a numerically lower absolute risk of MACE in patients with CACS 400-999 and ≥1000 (for 400-999: 3.5% 2.2% ; 4.7% vs 4.6% 2.9% ; 6.3% and for ≥1000: 4.8% 95% CI 2.8%; 6.7% vs. 5.8% 95% CI 3.3%; 8.3%), P=0.48. Bleeding risk did not differ significantly between ASA vs. no ASA (Figure 1). Among smokers, ASA use was not associated with a significant reduction in MACE risk across all CACS categories (all P for risk difference 0.05) In the CACS group ≥1000, event rates were similar between ASA users and non-users (8.8% 95% CI 6.8% ; 10.8% vs. 8.0% 95% CI 5.8% ; 10.3%, P=0.58). Bleeding risks in the smoking group were generally higher with ASA use across all CACS levels, except for those with CACS ≥1000. In general, smokers had numerically higher MACE and bleeding risks than non-smokers (Figure 1). Conclusion ASA use for primary prevention was not associated with reduced risk of MACE across CACS categories or with a significant impact on bleeding risk in smokers and non-smokers undergoing CCTA. These findings suggest that ASA may have limited preventive effects in this population.Figure 1
Winther et al. (Sat,) reported a other. Aspirin use did not reduce major adverse cardiovascular event risk across coronary calcium scores in smokers undergoing CCTA, with no significant bleeding risk difference.