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Impact of aspirin on presentation and hospital outcomes in patients with acute coronary syndromes (The Global Registry of Acute Coronary Events [GRACE])

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Abstract

The long-term use of aspirin (ASA) reduces the risk of subsequent acute coronary syndromes in patients with coronary artery disease (CAD). It is less clear whether ASA therapy benefits patients who develop an acute coronary syndrome despite its use. Baseline characteristics, type of acute coronary syndrome, and in-hospital events were compared on the basis of previous use of ASA in 11,388 patients with and without a history of CAD presenting to 94 multinational hospitals. A total of 73.0% of patients with a history of CAD (n = 4,974) were previously on long-term ASA therapy compared with 19.4% of patients without a history of CAD (n = 6,414). After multivariate regression analysis controlling for various potentially confounding factors, patients with a history of CAD who were previously taking ASA were significantly less likely to present with ST-segment elevation myocardial infarction (MI) (adjusted odds ratio [OR] 0.52, 95% confidence intervals [CI] 0.44 to 0.61) or die during hospitalization (OR 0.69, 95% CI 0.50 to 0.95) in comparison to patients who were not taking ASA. Patients without a history of CAD and who were previously taking ASA also had a lower risk of developing ST-segment elevation MI (OR 0.35, 95% CI 0.30 to 0.40) and a trend toward a decreased hospital death rate (OR 0.77, 95% CI 0.55 to 1.07). These results demonstrate that patients with a history of CAD who present with an acute coronary syndrome despite prior ASA use have less severe clinical presentation, fewer hospital complications, and lower in-hospital death rates than patients not previously taking ASA.

Section snippets

Methods

Full details of the GRACE rationale and methods have been previously published1 and are outlined in the following.

Results

The study population consisted of 11,388 men and women with acute coronary syndrome, enrolled in GRACE from July 1999 to June 2001, for whom information about long-term use of ASA was available. A total of 4,974 patients (43.7%) had a history of CAD, whereas 6,414 patients did not. Among the patients with a history of CAD, 3,629 (73.0%) were on long-term ASA therapy, whereas 1,243 (19.4%) of those without a history of CAD had been on ASA. Regional differences in the prior use of ASA in patients

Use of asa and its impact in patients without a history of cad:

The Physicians Health Study and the British Doctors’ Study both documented impressive reductions in the risk of an initial MI (∼32%) in healthy men randomized to ASA treatment, but these studies were unable to show significant reductions in stroke or cardiovascular mortality.4, 5 More recently, a randomized 2 × 2 trial examining the use of ASA and vitamin E therapy in 4,495 patients with ≥1 cardiac risk factors, but without clinically apparent CAD, was discontinuted prematurely after 3.6 years

References (12)

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The GRACE project is supported by an unrestricted educational grant from Aventis Pharmaceuticals, Philadelphia, Pennsylvania.

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