학술논문
Association of Aspirin Treatment With Cardiac Allograft Vasculopathy Progression and Adverse Outcomes After Heart Transplantation.
Document Type
Academic Journal
Author
Asleh R; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Heart Institute, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University, Jerusalem 90000, Israel. Electronic address: rasleh@gmail.com.; Briasoulis A; Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, Iowa.; Smith B; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.; Lopez C; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.; Alnsasra H; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.; Pereira NL; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.; Edwards BS; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.; Clavell AL; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.; Stulak JM; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.; Locker C; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.; Kremers WK; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.; Daly RC; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.; Lerman A; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.; Kushwaha SS; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address: kushwaha.sudhir@mayo.edu.
Source
Publisher: Churchill Livingstone Country of Publication: United States NLM ID: 9442138 Publication Model: Print Cited Medium: Internet ISSN: 1532-8414 (Electronic) Linking ISSN: 10719164 NLM ISO Abbreviation: J Card Fail Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Enhanced platelet reactivity may play a role in cardiac allograft vasculopathy (CAV) progression. The use of antiplatelet agents after heart transplantation (HT) has been inconsistent and although aspirin (ASA) is often a part of the medication regimen after HT, limited evidence is available on its benefit.
Methods and Results: CAV progression was assessed by measuring the difference in plaque volume and plaque index between the last follow-up and the baseline coronary intravascular ultrasound examination. Overall, 529 HT recipients were retrospectively analyzed (337 had ≥2 intravascular ultrasound studies). The progression in plaque volume (P = .007) and plaque index (P = .002) was significantly attenuated among patients treated with early ASA (within the first year after HT). Over a 6.7-year follow-up, all-cause mortality was lower with early ASA compared with late or no ASA use (P < .001). No cardiac deaths were observed in the early ASA group, and the risk of CAV-related graft dysfunction was significantly lower in this group (P = .03). However, the composite of all CAV-related events (cardiac death, CAV-related graft dysfunction, or coronary angioplasty) was not significantly different between the groups (P = .16).
Conclusions: Early ASA use after HT may delay CAV progression and decrease mortality and CAV-related graft dysfunction, but does not seem to affect overall CAV-associated events.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Methods and Results: CAV progression was assessed by measuring the difference in plaque volume and plaque index between the last follow-up and the baseline coronary intravascular ultrasound examination. Overall, 529 HT recipients were retrospectively analyzed (337 had ≥2 intravascular ultrasound studies). The progression in plaque volume (P = .007) and plaque index (P = .002) was significantly attenuated among patients treated with early ASA (within the first year after HT). Over a 6.7-year follow-up, all-cause mortality was lower with early ASA compared with late or no ASA use (P < .001). No cardiac deaths were observed in the early ASA group, and the risk of CAV-related graft dysfunction was significantly lower in this group (P = .03). However, the composite of all CAV-related events (cardiac death, CAV-related graft dysfunction, or coronary angioplasty) was not significantly different between the groups (P = .16).
Conclusions: Early ASA use after HT may delay CAV progression and decrease mortality and CAV-related graft dysfunction, but does not seem to affect overall CAV-associated events.
(Copyright © 2021 Elsevier Inc. All rights reserved.)