Clinical efficacy of aspirin with identification of intimal morphology by optical coherence tomography in preventing event recurrence in patients with vasospasm-induced acute coronary syndrome

Abstract

Using optical coherence tomography (OCT), we found that there were morphological differences in the coronary intima between patients with vasospasm-induced acute coronary syndrome (VACS) and those with stable variant angina. We investigated whether aspirin use would protect against chest pain recurrence in patients with VACS. A retrospective cohort study was performed. Patients with ST-segment elevation who were confirmed to have VACS by a provocation test were included. OCT was performed at the index event and when chest pain recurred to assess intimal morphology. Chest pain recurrence was defined as the first revisit to the emergency room with angina. Propensity score matching was performed between the aspirin and non-aspirin groups. For 48 months, 154 patients were followed (77 patients in each group). The baseline characteristics and OCT findings were well balanced between the two groups after propensity score matching. Myocardial infarction (17 vs. 3%, p = 0.003) and chest pain recurrence (26 vs. 9%, p = 0.006) occurred more frequently in the non-aspirin group than in the aspirin group. Multiple Cox regression analysis showed that aspirin use was a significant predictor of lower risk of myocardial infarction [hazard ratio (HR) 0.13; 95% confidence interval (CI) 0.03-0.61] and chest pain recurrence (HR 0.33; 95% CI 0.12-0.71) during the follow-up period, after adjustments for relevant covariates including OCT findings. The use of aspirin may have a preventive effect on myocardial infarction and chest pain recurrence in patients with VACS. Randomized controlled trials are necessary to confirm the result.

Impact of aspirin use on clinical outcomes in patients with vasospastic angina: a systematic review and meta-analysis

“…The search engines were reviewed to identify 3645 related studies, among which 1303 articles were duplicates and 2414 articles did not fulfil the inclusion criteria and were excluded from the study. After removing these studies, four propensity-matched cohorts, 11 13 14 16 one retrospective analysis 12 and one prospective multicentre cohort 15 ( figure 1 ), including a total of 3661 patients (aspirin group, n=1695; no aspirin group, n=1966, table 1 ) were included in the study. Four studies underwent coronary provocation test, except for one study (Seong-Sik Cho, 2019) that used the electrocardiograph provocation test.…”

“… 13 In contrast, MI (HR=0.13; CI: 0.03 to 0.61; p=0.014) and chest pain recurrence (HR=0.29; CI: 0.12 to 0.71; p=0.006) were observed by Lee et al to have been significantly reduced by aspirin use among VSA patients during follow-up. 11 Lee et al showed that acute intimal tears and erosion identified by optical coherence tomography are susceptible to thrombosis leading to MI. Therefore, aspirin was evidenced to reduce adverse events in VSA patients with a greater number of thrombotic intracoronary lesions.…”

“…Our meta-analysis indicates that aspirin use may not be linked to a lower risk of MACE and cardiac death. The subgroup analysis of MACE indicated that the studies by Lee 11 and Lim 13 were heterogeneous. The origin of heterogeneity in these studies may be attributable to chest pain recurrence in the MACE, which results in an entirely different outcome due to the definition.…”

“…8 Owing to the latest controversy and reduced usage of aspirin in preventing cardiovascular events, 9 10 aspirin's efficiency in VSA patients without significant stenosis has not yet been reported. [11][12][13][14][15][16] Therefore, this meta-analysis was designed to assess the correlation between aspirin use and cardiovascular events and cardiac death among VSA patients during long-term follow-up.…”

Cardiovascular imaging 2018 in the International Journal of Cardiovascular Imaging

“…In a retrospective cohort study they followed for 48 months 154 patients who presented with VACS: using propensity score matching those patients were divided in equal groups of nonaspirin and aspirin use. Myocardial infarction (17% vs. 3%, p = 0.003) and chest pain recurrence (26% vs. 9%, p = 0.006) occurred more frequently in the non-aspirin group, showing that aspirin may have a protective effect on patients presenting with VACS [20].…”