title: Aspirin resistance determined from a bed-side test in patients suspected to have acute coronary syndrome portends a worse 6 months outcome.
abstract: BACKGROUND
  Coronary patients resistant to aspirin may have increased risk for ischemic events. Little data were available for patients presenting acutely with chest pain.
  
  
  RESULTS
  We used the VerifyNow Aspirin to determine aspirin responsiveness of 314 patients regularly taking aspirin 75-300 mg daily for >or=4 weeks who presented with suspected acute coronary syndrome in Emergency Department. Aspirin resistance was defined as an aspirin reaction unit (ARU) >or=550, and the clinical team was blinded to the ARU reading. The pre-specified study endpoints were the diagnosis of acute myocardial infarction (AMI) for the index admission and major adverse cardiac events including cardiovascular death or recurrent acute coronary syndrome requiring hospitalization within 6 months. Aspirin resistance was noted in 30 (9.6%) patients. There was no difference in the diagnosis of AMI for the index presentation (3/30, 10% vs. 25/284, 8.8%, P = 0.91). Among the 312 hospital survivors, aspirin resistant patients had increased adverse events over 6 months with an overall hazard ratio of 10.0 [95% confidence interval (CI) 4.6-22.0]. After adjusted for elevated Troponin-T, the only confounder in the model, the hazard ratio was 11.1 (95% CI 4.7-26.0). Results were similar in patients treated only medically without revascularization (adjusted hazard ratio 12.1, 95% CI 4.7-26.4). The increased events were observed both from discharge to 30 days and from 30 days to 6 months.
  
  
  CONCLUSIONS
  Aspirin resistance occurs in approximately 10% of patients presenting with suspected acute coronary syndrome and is associated with adverse cardiac events.
authors.affiliation: Department of Cardiology, Dunedin Public Hospital, Dunedin School of Medicine, University of Otago, New Zealand.
authors.forename: J W
authors.initials: JW
authors.lastname: Chu
authors.forename: C-K
authors.initials: CK
authors.lastname: Wong
authors.forename: J
authors.initials: J
authors.lastname: Chambers
authors.forename: J Vant
authors.initials: JV
authors.lastname: Wout
authors.forename: P
authors.initials: P
authors.lastname: Herbison
authors.forename: E W
authors.initials: EW
authors.lastname: Tang
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use*; D004351:Drug Resistance; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D020107:Troponin T / Q000097:blood
chemical_list: D010975:Platelet Aggregation Inhibitors; D020107:Troponin T; D001241:Aspirin