The clinical outcomes of percutaneous coronary intervention performed without pre-procedural aspirin

Abstract

Objectives: The purpose of this study was to examine the incidence and outcomes of percutaneous coronary intervention (PCI) performed in patients who had not received pre-procedural aspirin.

Background: Aspirin is an essential component of peri-PCI pharmacotherapy. Previous studies suggest that pre-procedural aspirin is not administered to a clinically significant number of patients undergoing PCI.

Methods: We evaluated the incidence of PCIs performed without pre-procedural aspirin use among patients undergoing PCI from January 2010 through December 2011 at 44 hospitals in Michigan. Propensity-matched multivariate analysis was used to adjust for the nonrandom use of aspirin.

Results: Our study population comprised 65,175 patients, of whom 4,640 (7.1%) did not receive aspirin within 24 h before undergoing PCI. Aspirin nonreceivers were more likely to have had previous gastrointestinal bleeding or to present with cardiogenic shock or after cardiac arrest. In the propensity-matched analysis, absence of aspirin before PCI was associated with a higher rate of death (3.9% vs. 2.8%; odds ratio: 1.89 [95% confidence interval: 1.32 to 2.71], p < 0.001) and stroke (0.5% vs. 0.1%; odds ratio: 4.24 [95% confidence interval: 1.49 to 12.11], p = 0.007) with no difference in need for transfusions. This association was consistent across multiple pre-specified subgroups.

Conclusions: A significant number of patients do not receive aspirin before undergoing PCI. Lack of aspirin before PCI was associated with significantly increased in-hospital mortality and stroke. Our study results support the need for quality efforts focused on optimizing aspirin use before PCI.

Keywords: ASA; BMC2; Blue Cross Blue Shield of Michigan Cardiovascular Consortium; CABG; CI; CIN; OR; PCI; aspirin; confidence interval; contrast-induced nephropathy; coronary artery bypass grafting; death; in-hospital outcomes; odds ratio; percutaneous coronary intervention.