Bavry Anthony A, Gong Yan, Handberg Eileen M, Cooper-DeHoff Rhonda M, Pepine Carl J
North Florida/South Georgia Veterans Health System, Gainesville, Fla; College of Medicine, University of Florida, Gainesville.
College of Pharmacy, University of Florida, Gainesville.
Am J Med. 2015 Feb;128(2):137-43. doi: 10.1016/j.amjmed.2014.09.028. Epub 2014 Oct 15.
Aspirin is recommended in stable coronary artery disease based on myocardial infarction and stroke studies. However, benefit among stable coronary artery disease patients who have not suffered an acute ischemic event is uncertain. The objective of this study was to evaluate the impact of aspirin in stable coronary artery disease. We hypothesized that aspirin's benefit would be attenuated among individuals with stable coronary artery disease but no prior ischemic event.
An observational study was conducted from the INternational VErapamil-SR/Trandolapril STudy cohort. Ambulatory patients ≥ 50 years of age with clinically stable coronary artery disease requiring antihypertensive drug therapy (n = 22,576) were classified "ischemic" if they had a history of unstable angina, myocardial infarction, transient ischemic attack, or stroke at the baseline visit. All others were classified "non-ischemic." Aspirin use was updated at each clinic visit and considered as a time-varying covariate in a Cox regression model. The primary outcome was first occurrence of all-cause mortality, myocardial infarction, or stroke.
At baseline, 56.7% of all participants used aspirin, which increased to 69.3% at study close out. Among the "non-ischemic" group (n = 13,091), aspirin was not associated with a reduction in risk (hazard ratio [HR] 1.11; 95% confidence interval [CI], 0.97-1.28; P = .13); however, among the "ischemic" group (n = 9485), aspirin was associated with a reduction in risk (HR 0.87; 95% CI, 0.77-0.99; P = .033).
In patients with stable coronary artery disease and hypertension, aspirin use was associated with reduced risk for adverse cardiovascular outcomes among those with prior ischemic events. Among patients with no prior ischemic events, aspirin use was not associated with a reduction in risk.
基于心肌梗死和中风研究，阿司匹林被推荐用于稳定型冠状动脉疾病。然而，在未发生急性缺血事件的稳定型冠状动脉疾病患者中，其益处尚不确定。本研究的目的是评估阿司匹林对稳定型冠状动脉疾病的影响。我们假设，在患有稳定型冠状动脉疾病但无既往缺血事件的个体中，阿司匹林的益处会减弱。
一项观察性研究基于国际维拉帕米缓释片/群多普利研究队列进行。年龄≥50岁、患有临床稳定型冠状动脉疾病且需要抗高血压药物治疗的门诊患者（n = 22,576），如果在基线访视时有不稳定型心绞痛、心肌梗死、短暂性脑缺血发作或中风病史，则被分类为“缺血性”。所有其他患者被分类为“非缺血性”。每次门诊就诊时更新阿司匹林的使用情况，并在Cox回归模型中视为时变协变量。主要结局是全因死亡、心肌梗死或中风的首次发生。
在基线时，所有参与者中有56.7%使用阿司匹林，在研究结束时这一比例增至69.3%。在“非缺血性”组（n = 13,091）中，阿司匹林与风险降低无关（风险比[HR] 1.11；95%置信区间[CI]，0.97 - 1.28；P = 0.13）；然而，在“缺血性”组（n = 9485）中，阿司匹林与风险降低有关（HR 0.87；95% CI，0.77 - 0.99；P = 0.033）。
在患有稳定型冠状动脉疾病和高血压的患者中，使用阿司匹林与既往有缺血事件的患者不良心血管结局风险降低有关。在无既往缺血事件的患者中，使用阿司匹林与风险降低无关。
