![]() Myocardial infarction (MI) was diagnosed based on the 3rd universal definition of MI. Therefore, the final dataset included 442 patients with 442 culprit lesions. We further excluded from the analysis lesions in which balloon angioplasty was required before OCT imaging or those with insufficient image quality. The exclusion criteria for OCT imaging were patients with cardiogenic shock, congestive heart failure, significant left main disease, and suboptimal results after thrombectomy with Thrombolysis in Myocardial Infarction (TIMI) 0–2 flow. Therefore, we conducted a retrospective analysis to investigate the morphological differences of culprit lesions of ACS between patients with and without prior ASA use at their first presentation of ACS.įrom a total of 1,150 patients with ACS treated with percutaneous coronary intervention (PCI) at Tsuchiura Kyodo General Hospital between October 2008 and December 2015, we identified 511 patients with their first presentation of ACS who underwent OCT examinations of the de novo culprit lesion at the time of PCI. Optical coherence tomography (OCT) is an unprecedented imaging modality, which enables in vivo assessment of coronary plaque and intracoronary thrombus with near-pathology resolution. Of note, the effect of prior ASA use on the local pathogenesis of culprit lesions in ACS has not been elucidated. Thus, despite clinical data and reasonable pharmacological action against thromboembolism, the effects of ASA on the presentation of first ACS continue to be debated. 2Īlthough previous reports suggested the efficacy of ASA for primary prevention in high-risk subjects with diabetes, recent studies cast doubt on this finding. Moreover, in contrast to secondary prevention, the benefit of ASA for primary prevention has been controversial. However, there remains controversy whether prior ASA use is an independent risk for worse outcomes or only a marker of different high-risk features. 1 – 3ĭespite its protective actions against coronary thrombi and its proven effectiveness in ACS patients, the prior use of ASA in advance of a presentation of non-ST-elevation ACS is reported as a high-risk feature for subsequent adverse events. With a first ACS presentation, patients with prior ASA use were more likely to present with non-ST-elevation ACS with less frequent intraluminal thrombi, but no significant difference in underlying plaque characteristics or clinical course.īased on substantial evidence, acetylsalicylic acid (ASA), also known as aspirin, has for decades been accepted as the first-line antithrombotic agent for the treatment of acute coronary syndrome (ACS) and for secondary prevention in patients with cardiovascular disease. Rate of adverse events did not differ between the ASA and the non-ASA groups in the matched cohort. 75.5%, P<0.001), whereas no significant difference was observed in plaque characteristics. OCT revealed less frequent thrombi in the ASA than in the non-ASA group in both the entire (37.3 vs. Propensity score matching yielded 49 patients in both groups. ![]() Non-ST-elevation ACS was more prevalent in the ASA than in the non-ASA group (79.1 vs. The ASA group was older, had higher frequency of dyslipidemia and hypertension, and lower renal function than the non-ASA group. 67 patients (15.2%) had received ASA at presentation. Clinical characteristics, OCT findings, and adverse events at 30 days were compared between patients with prior ASA use and ASA-naïve patients (non-ASA). In total, 442 patients with their first ACS episode undergoing OCT for the culprit lesions were investigated. This study used optical coherence tomography (OCT) to investigate the morphological features of culprit lesions of ACS in patients with prior ASA use. The effect of prior use of aspirin (ASA) on the onset of acute coronary syndrome (ACS) has not been clarified. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
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