Aspirin use was not associated with lower MACE risk or increased major bleeding across all CACS categories in individuals aged ≥65 or <65 years undergoing cardiac CT angiography.
Does aspirin use reduce two-year MACE or increase bleeding in adult individuals undergoing CCTA for suspected chronic coronary syndrome across different CACS categories?
Aspirin use for primary prevention in individuals undergoing CCTA for suspected chronic coronary syndrome showed no benefit in reducing MACE across all CACS categories and age groups.
Absolute Event Rate: 0% vs 0%
Abstract Background Aspirin is widely used for secondary prevention of major adverse cardiovascular events (MACE), but the risk-benefit ratio in older individuals receiving aspirin for primary prevention remains controversial due to bleeding risk. Purpose To investigate the relationship between aspirin use and risks of MACE and bleeding across coronary artery calcium score (CACS) categories among younger (65 years) versus older (≥65 years) individuals undergoing calcium scoring and cardiac computed tomography angiography (CCTA) due to suspected chronic coronary syndrome. Methods A registry-based study of adult individuals who underwent CCTA for suspected chronic coronary syndrome from 2008 through 2022 with a corresponding CACS. Aspirin use was defined as at least one filled prescription for aspirin within 180 days before through 180 days after CCTA. Individuals were stratified by aspirin use (yes/no), CACS category (0, 1–99, 100–399, 400–999, ≥1000), and age group (65 vs. ≥65 years). Main exclusion criteria included a history of acute coronary syndrome, coronary interventions, stroke, or a filled prescription for aspirin more than 180 days before CCTA, anticoagulant drugs, or P2Y12 inhibitor The primary endpoint was two-year MACE, defined as death from any cause, acute coronary syndrome, stroke, or coronary revascularization . The secondary endpoint was major bleeding requiring hospitalization. Absolute risks were calculated for each subgroup, standardized for age, sex, selected comorbidities, and pharmacotherapy distributions of all included subjects. Results A total of 65,519 individuals were included, with 47,292 (72.2%) aged 65 years of whom 12,639 (27.2%) filled a prescription for aspirin. The ≥65-year group comprised 18,227 individuals (27.8%) of whom 6,716 (36.8%) filled a prescription for aspirin. In the 65 age group, for lower CACS categories 1000, no significant differences in MACE risk were observed (Figure 1). For the group of aspirin users 65 with CACS ≥1000 we observed a numerically lower risk of MACE, although not statistically significant (6.2% 95% CI 3.6%; 8.7% vs. 8.0% 95% CI 4.1%; 11.9%, P for risk difference=0.42). In the ≥65 age group, no significant differences in risk of MACE were observed across all CACS categories (all P for risk difference0.05; Figure 1). In both age groups no significant difference for bleeding was observed across all CACS categories (Figure 1). Generally, no clear benefit of aspirin use was seen across all CACS categories in either of the age groups. However, as expected, absolute risks were generally higher for the ≥65 group compared with the 65 age group for both MACE and bleeding events. Conclusion No benefit of aspirin for primary prevention was seen in neither younger nor older individuals who underwent cardiac computed tomography angiography across all coronary artery calcium score categories. The absolute risks of MACE and bleeding were higher in older versus younger individuals.Figure 1
Noehr et al. (Sat,) reported a other. Aspirin use was not associated with lower MACE risk or increased major bleeding across all CACS categories in individuals aged ≥65 or <65 years undergoing cardiac CT angiography.