Document Detail

Aspirin resistance determined from a bed-side test in patients suspected to have acute coronary syndrome portends a worse 6 months outcome.
MedLine Citation:
PMID:  20356848     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Coronary patients resistant to aspirin may have increased risk for ischemic events. Little data were available for patients presenting acutely with chest pain.
METHODS AND RESULTS: We used the VerifyNow Aspirin to determine aspirin responsiveness of 314 patients regularly taking aspirin 75-300 mg daily for >or=4 weeks who presented with suspected acute coronary syndrome in Emergency Department. Aspirin resistance was defined as an aspirin reaction unit (ARU) >or=550, and the clinical team was blinded to the ARU reading. The pre-specified study endpoints were the diagnosis of acute myocardial infarction (AMI) for the index admission and major adverse cardiac events including cardiovascular death or recurrent acute coronary syndrome requiring hospitalization within 6 months. Aspirin resistance was noted in 30 (9.6%) patients. There was no difference in the diagnosis of AMI for the index presentation (3/30, 10% vs. 25/284, 8.8%, P = 0.91). Among the 312 hospital survivors, aspirin resistant patients had increased adverse events over 6 months with an overall hazard ratio of 10.0 [95% confidence interval (CI) 4.6-22.0]. After adjusted for elevated Troponin-T, the only confounder in the model, the hazard ratio was 11.1 (95% CI 4.7-26.0). Results were similar in patients treated only medically without revascularization (adjusted hazard ratio 12.1, 95% CI 4.7-26.4). The increased events were observed both from discharge to 30 days and from 30 days to 6 months.
CONCLUSION: Aspirin resistance occurs in approximately 10% of patients presenting with suspected acute coronary syndrome and is associated with adverse cardiac events.
J W Chu; C-K Wong; J Chambers; J Vant Wout; P Herbison; E W Tang
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-03-30
Journal Detail:
Title:  QJM : monthly journal of the Association of Physicians     Volume:  103     ISSN:  1460-2393     ISO Abbreviation:  QJM     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-24     Completed Date:  2010-12-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9438285     Medline TA:  QJM     Country:  England    
Other Details:
Languages:  eng     Pagination:  405-12     Citation Subset:  IM    
Department of Cardiology, Dunedin Public Hospital, Dunedin School of Medicine, University of Otago, New Zealand.
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MeSH Terms
Acute Coronary Syndrome / drug therapy*
Aged, 80 and over
Aspirin / therapeutic use*
Drug Resistance*
Epidemiologic Methods
Middle Aged
Platelet Aggregation Inhibitors / therapeutic use*
Platelet Function Tests
Troponin T / blood
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Troponin T; 50-78-2/Aspirin

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