Peled Yael, Lavee Jacob, Raichlin Eugenia, Katz Moshe, Arad Michael, Kassif Yigal, Peled Amir, Asher Elad, Elian Dan, Har-Zahav Yedael, Shlomo Nir, Freimark Dov, Goldenberg Ilan, Klempfner Robert
The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clin Transplant. 2017 Dec;31(12). doi: 10.1111/ctr.13133.
Cardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality after heart transplantation (HT). Enhanced platelet reactivity is a contributing factor. We aimed to investigate the association between early initiation of aspirin therapy post-HT and the 15-year risk of the development of CAV.
We studied 206 patients who underwent HT between 1991 and 2016. Multivariate Cox proportional hazards regression modeling was employed to evaluate the association between early aspirin initiation and the long-term risk of CAV.
Ninety-seven patients (47%) received aspirin therapy. At 15 years of follow-up, the rate of CAV was lowered by sixfold in patients treated with aspirin compared with the non-treated patients: 7% vs 37% (log-rank P-value<.001). The corresponding rates of the combined end-point of CAV or death were also lower in patients treated with aspirin, compared with the non-treated patients: 42% vs 78% (log-rank P < .001). Consistently, multivariate analysis showed that early aspirin therapy was associated with a significant 84% (P < .001) reduction in CAV risk, and with a corresponding 68% (P < .0001) reduction in the risk of the combined end-point of CAV or death. We further validated these results using a propensity score-adjusted Cox model.
Early aspirin initiation is independently associated with a significant reduction in the risk of CAV.
心脏移植血管病变（CAV）是心脏移植（HT）后发病和死亡的主要原因。血小板反应性增强是一个促成因素。我们旨在研究心脏移植后早期开始使用阿司匹林治疗与CAV发生的15年风险之间的关联。
我们研究了1991年至2016年间接受心脏移植的206例患者。采用多变量Cox比例风险回归模型来评估早期使用阿司匹林与CAV长期风险之间的关联。
97例患者（47%）接受了阿司匹林治疗。在15年的随访中，与未接受治疗的患者相比，接受阿司匹林治疗的患者CAV发生率降低了6倍：7%对37%（对数秩P值<.001）。与未接受治疗的患者相比，接受阿司匹林治疗的患者CAV或死亡联合终点的相应发生率也较低：42%对78%（对数秩P<.001）。同样，多变量分析表明，早期阿司匹林治疗与CAV风险显著降低84%（P<.001）相关，与CAV或死亡联合终点风险相应降低68%（P<.0001）相关。我们使用倾向评分调整的Cox模型进一步验证了这些结果。
早期开始使用阿司匹林与CAV风险显著降低独立相关。
