Author + information
- Received May 10, 2012
- Revision received June 26, 2012
- Accepted July 4, 2012
- Published online December 1, 2012.
- Jennifer Yu, MBBS⁎,†,
- Roxana Mehran, MD⁎,‡,⁎ (, )
- George D. Dangas, MD, PhD⁎,‡,
- Bimmer E. Claessen, MD‡,
- Usman Baber, MD⁎,
- Ke Xu, PhD‡,
- Helen Parise, ScD‡,
- Martin Fahy, MSc‡,
- Alexandra J. Lansky, MD§,
- Bernhard Witzenbichler, MD‖,
- Cindy L. Grines, MD¶,
- Giulio Guagliumi, MD#,
- Ran Kornowski, MD⁎⁎,
- Jochen Wöhrle, MD††,
- Dariusz Dudek, MD, PhD‡‡,
- Giora Weisz, MD⁎,§§ and
- Gregg W. Stone, MD⁎,§§
- ↵⁎Reprint requests and correspondence:
Dr. Roxana Mehran, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, New York 10029
Objectives This study sought to examine the relationship between the aspirin dose prescribed at hospital discharge and long-term outcomes after ST-segment elevation myocardial infarction in patients treated with primary percutaneous coronary intervention (PCI).
Background Patients with ST-segment elevation myocardial infarction who undergo primary PCI are prescribed maintenance aspirin doses that vary between 75 and 325 mg daily. Whether the dose of aspirin affects long-term patient outcomes is unknown.
Methods We compared 3-year outcomes in patients who were prescribed high-dose (>200 mg daily) versus low-dose (≤200 mg daily) aspirin from the large-scale HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial.
Results Among 2,851 patients, 2,289 patients (80.3%) were discharged on low-dose aspirin and 562 patients (19.7%) were discharged on high-dose aspirin. Patients discharged on high-dose rather than low-dose aspirin were more likely to have a history of hypertension, hyperlipidemia, family history of premature coronary disease, prior treatment with PCI or coronary artery bypass surgery, and to be enrolled in the United States. Patients discharged on high-dose aspirin had higher 3-year rates of major adverse cardiovascular events, reinfarction, ischemic target vessel revascularization, major bleeding, and stent thrombosis. After multivariable analysis, discharge on high-dose aspirin was an independent predictor of major bleeding (hazard ratio: 2.80; 95% confidence interval: 1.31 to 5.99; p = 0.008), but not of adverse ischemic events.
Conclusions In patients with ST-segment elevation myocardial infarction undergoing primary PCI, discharge on high-dose rather than low-dose aspirin may increase the rate of major bleeding without providing additional ischemic benefit.
The HORIZONS-AMI trial was funded by Boston Scientific and The Medicines Company. Drs. Mehran and Dangas have served as consultants to AstraZeneca, Abbott Vascular, Johnson & Johnson, Merck Sharp & Dohme, and Maya Medical; have served on the advisory board of Regado; and have received research grants from BMS/Sanofi, Daiichi-Sankyo/Eli Lilly and Company, and The Medicines Company. Dr. Witzenbichler has received lecture fees from The Medicines Company and Boston Scientific Corporation. Dr. Grines has received consultant fees/honoraria/speakers’ fees for Abbott Vascular, ABIOMED, Daiichi-Sankyo/Eli Lilly and Company, and The Medicines Company. Dr. Guagliumi has served as a consultant to Boston Scientific Corporation, St. Jude Medical, and Volcano Corporation and has received research grants from Abbott Vascular, Boston Scientific Corporation, and St. Jude Medical. Dr. Dudek has received research grants from Boston Scientific Corporation, St. Jude Medical, and Volcano Corporation and has served as a consultant to Boston Scientific Corporation and St. Jude Medical. Dr. Stone has served as a consultant to Volcano Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 10, 2012.
- Revision received June 26, 2012.
- Accepted July 4, 2012.
- American College of Cardiology Foundation