Aspirin resistance and adverse clinical events in patients with coronary artery disease.
OBJECTIVE
We sought to determine the clinical significance of aspirin resistance measured by a point-of-care assay in stable patients with coronary artery disease (CAD).


METHODS
We used the VerifyNow Aspirin (Accumetrics Inc, San Diego, Calif) to determine aspirin responsiveness of 468 stable CAD patients on aspirin 80 to 325 mg daily for > or =4 weeks. Aspirin resistance was defined as an Aspirin Reaction Unit > or =550. The primary outcome was the composite of cardiovascular death, myocardial infarction (MI), unstable angina requiring hospitalization, stroke, and transient ischemic attack.


RESULTS
Aspirin resistance was noted in 128 (27.4%) patients. After a mean follow-up of 379+/-200 days, patients with aspirin resistance were at increased risk of the composite outcome compared to patients who were aspirin-sensitive (15.6% vs 5.3%, hazard ratio [HR] 3.12, 95% confidence intervals [CI], 1.65-5.91, P < .001). Cox proportional hazard regression modeling identified aspirin resistance, diabetes, prior MI, and a low hemoglobin to be independently associated with major adverse long-term outcomes (HR for aspirin resistance 2.46, 95% CI, 1.27-4.76, P = .007).


CONCLUSIONS
Aspirin resistance, defined by an aggregation-based rapid platelet function assay, is associated with an increased risk of adverse clinical outcomes in stable patients with CAD.
Chen
Wai-Hong
WH
Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. whchen@hku.hk
Cheng
Xi
X
Lee
Pui-Yin
PY
Ng
William
W
Kwok
Jeanette Yat-Yin
JY
Tse
Hung-Fat
HF
Lau
Chu-Pak
CP
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality*; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin