No aspirin before heart op increases death risk

Patients who do not receive aspirin before they undergo coronary angioplasty have a higher risk of death, a new study reports.

Coronary angioplasty is a procedure to clear blocked heart arteries in order to restore blood flow. Leading medical groups recommend that patients receive aspirin before angioplasty, but this study found that this is not done in a surprisingly high number of cases.

Researchers analysed data from more than 65 000 patients who underwent angioplasty and placement of a stent to keep the artery open (together known as percutaneous coronary intervention or PCI) at one of 42 hospitals in Michigan in 2010 and 2011.

Of these patients, 7% did not receive aspirin as recommended within 24 hours before the procedure. About 90% of these patients had no documented reason for not being given aspirin, according to the study scheduled for presentation on March 11 at the annual meeting of American College of Cardiology (ACC), in San Francisco.

Cause-and-effect relationship

The findings highlight "an unexpectedly significant number of patients undergoing PCI without receiving aspirin, despite the lack of a documented [reason to avoid such treatment] in the majority of cases - even in institutions that are active participants in an ongoing quality-improvement initiative," lead investigator Dr Mohamad Kenaan, a cardiovascular medicine fellow with University of Michigan Health Systems, said in an ACC news release.

The in-hospital death rate for patients who did not receive aspirin was 3.9%, compared with 1.2% for those who did receive aspirin, the investigators found.

"The strong association our study demonstrated between aspirin non-use before PCI and worse outcomes, including in-hospital death, across all types of ischemic heart disease should be used as a platform for more studies to confirm our findings and motivate quality efforts focused on optimising aspirin use before PCI," Kenaan said.

"Our findings also may indicate lack of adherence to other guidelines, thus leading to worse outcomes."

While the study found an association between higher rates of in-hospital death and non-use of aspirin before PCI, it did not prove a cause-and-effect relationship.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The US National Heart, Lung, and Blood Institute has more about angioplasty.