The clinical outcomes of percutaneous coronary intervention performed without pre-procedural aspirin.
OBJECTIVE
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.
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.
Mohamad
M
Kenaan
Milan
M
Seth
Herbert D
HD
Aronow
David
D
Wohns
David
D
Share
Hitinder S
HS
Gurm
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000628:therapy*; D004363:Drug Utilization; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000592:standards; D057216:Propensity Score; D012042:Registries; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
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