title: Aspirin Desensitization in Patients With Coronary Artery Disease: Results of the Multicenter ADAPTED Registry (Aspirin Desensitization in Patients With Coronary Artery Disease).
abstract: There are limited data on aspirin (ASA) desensitization for patients with coronary artery disease. The aim of the present study was to assess the safety and efficacy of a standard rapid desensitization protocol in patients with ASA sensitivity undergoing coronary angiography.
  
  
  
  This is a prospective, multicenter, observational study including 7 Italian centers including patients with a history of ASA sensitivity undergoing coronary angiography with intent to undergo percutaneous coronary intervention. A total of 330 patients with history of ASA sensitivity with known/suspected stable coronary artery disease or presenting with an acute coronary syndrome, including ST-segment-elevation myocardial infarction were enrolled. Adverse effects to aspirin included urticaria (n=177, 53.6%), angioedema (n=69, 20.9%), asthma (n=65, 19.7%), and anaphylactic reaction (n=19, 5.8%). Among patients with urticaria/angioedema, 13 patients (3.9%) had a history of idiopathic chronic urticaria. All patients underwent a rapid ASA (5.5 hours) desensitization procedure. The desensitization procedure was performed before cardiac catheterization in all patients, except for those (n=78, 23.6%) presenting with ST-segment-elevation myocardial infarction who underwent the desensitization after primary percutaneous coronary intervention. Percutaneous coronary intervention was performed in 235 patients (71%) of the overall study population. The desensitization procedure was successful in 315 patients (95.4%) and in all patients with a history of anaphylactic reaction. Among the 15 patients (4.6%) who did not successfully respond to the desensitization protocol, adverse reactions were minor and responded to treatment with corticosteroids and antihistamines. Among patients with successful in-hospital ASA desensitization, 253 patients (80.3%) continued ASA for at least 12 months. Discontinuation of ASA in the 62 patients (19.7%) who had responded to the desensitization protocol was because of medical decision and not because of hypersensitivity reactions.
  
  
  
  A standard rapid desensitization protocol is safe and effective across a broad spectrum of patients, irrespective of the type of aspirin sensitivity manifestation, with indications to undergo coronary angiography with intent to perform percutaneous coronary intervention.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02848339.
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.). roberta.rossini2@gmail.com.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossini
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iorio
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Roberto
authors.initials: R
authors.lastname: Pozzi
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Matteo
authors.initials: M
authors.lastname: Bianco
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Sergio
authors.initials: S
authors.lastname: Leonardi
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Corrado
authors.initials: C
authors.lastname: Lettieri
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Irene
authors.initials: I
authors.lastname: Bossi
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Paola
authors.initials: P
authors.lastname: Colombo
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Stefano
authors.initials: S
authors.lastname: Rigattieri
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Cinzia
authors.initials: C
authors.lastname: Dossena
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Angelo
authors.initials: A
authors.lastname: Anzuini
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.affiliation: From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: acute coronary syndrome; aspirin; coronary artery disease; hypersensitivity; percutaneous coronary intervention