Aspirin for primary prevention of ST segment elevation myocardial infarction in persons with diabetes and multiple risk factors

Abstract

Background Controversy exists as to whether low-dose aspirin use may give benefit in primary prevention of cardiovascular (CV) events. We hypothesized that the benefits of aspirin are underevaluated. Methods We investigated 12,123 Caucasian patients presenting to hospital with acute coronary syndromes as first manifestation of CV disease from 2010 to 2019 in the ISACS-TC multicenter registry (ClinicalTrials.gov, NCT01218776). Individual risk of ST segment elevation myocardial infarction (STEMI) and its association with 30-day mortality was quantified using inverse probability of treatment weighting models matching for concomitant medications. Estimates were compared by test of interaction on the log scale. Findings The risk of STEMI was lower in the aspirin users (absolute reduction: 6·8%; OR: 0·73; 95%CI: 0·65–0·82) regardless of sex (p for interaction=0·1962) or age (p for interaction=0·1209). Benefits of aspirin were seen in patients with hypertension, hypercholesterolemia, and in smokers. In contrast, aspirin failed to demonstrate a significant risk reduction in STEMI among diabetic patients (OR:1·10;95%CI:0·89–1·35) with a significant interaction (p: <0·0001) when compared with controls (OR:0·64,95%CI:0·56–0·73). Stratification of diabetes in risk categories revealed benefits (p interaction=0·0864) only in patients with concomitant hypertension and hypercholesterolemia (OR:0·87, 95% CI:0·65–1·15), but not in smokers. STEMI was strongly related to 30-day mortality (OR:1·93; 95%CI:1·59–2·35) Interpretation Low-dose aspirin reduces the risk of STEMI as initial manifestation of CV disease with potential benefit in mortality. Patients with diabetes derive substantial benefit from aspirin only in the presence of multiple risk factors. In the era of precision medicine, a more tailored strategy is required. Funding None.

MIKB: A manually curated and comprehensive knowledge base for myocardial infarction

“…But early percutaneous coronary intervention (PCI) is the main treatment method in STEMI patients [30] . A number of studies have found that STEMI patients have a higher risk of short-term or long-term adverse events than NSTEMI patients [31] , [32] , [33] . Therefore, we used the five methods to describe the MI subtypes, including disease phase, lesion range, infarction location, ECG expression and clinical type in the first version of MIRKB.…”

The Safety of Celecoxib as an Acute Treatment for Migraine: A Narrative Review

“…In clinical trials, elevated CV risks appear to be class-specific to selective COX-2 inhibitors with increased COX-2 specificity, higher dose, and longer duration increasing the AE risk exposure [ 21 , 29 – 32 ]. Many NSAIDS (e.g., ibuprofen, diclofenac, naproxen, and celecoxib) increase the risk of heart failure by approximately two-fold, linked in part to the renal COX-2-mediated effects on BP and sodium retention [ 22 , 32 ].…”

Early Use of Aspirin after Symptoms in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

“…5 Aspirin intervention is one of the most effective and immediate medication of patients with STEMI. 6 The standard guidelines recommend that aspirin 300 mg be given orally as soon as possible by emergency medical personnel. 7 As a result, pre-hospital aspirin use has been found to improve the outcome of STEMI and is considered safe.…”

“…7 As a result, pre-hospital aspirin use has been found to improve the outcome of STEMI and is considered safe. 6,8 Patients who got aspirin during the first four hours after start of symptoms had a reduced death rate than those who received aspirin after five to eight hours. 9 Even after adjustment for potential confounders like gender, age, history of heart disease and medication, early use of aspirin remained independently correlated with smaller infarct size and non-Q wave.…”