Aspirin offers no protection against cardiac events in asymptomatic coronary stenosis

Asymptomatic individuals with incidentally diagnosed coronary artery stenosis may forego the use of aspirin, with a recent study suggesting that it does not provide any significant benefit for the prevention of composite events and bleeding.

“Thus, personalized aspirin use rather than universal aspirin use may be more appropriate for this population,” the authors said.

A total of 41,441 asymptomatic individuals who underwent coronary computed tomographic angiography during health checkups between 2007 and 2022 were screened in this propensity score-matching study. Of these, 1,483 with incidentally diagnosed coronary stenosis met the eligibility criteria. Analysis was carried out using data from 636 individuals (318 new aspirin users and 318 controls).

Eleven individuals in the aspirin group and 18 in the control group experienced composite events (ie, cardiovascular death, nonfatal myocardial infarction, and nonfatal ischaemic stroke/transient ischaemic attack) over a median follow-up of 6.3 years (hazard ratio, 0.62; p=0.20).

Additionally, composite events and major bleeding occurred in 26 aspirin users and 23 controls (hazard ratio, 1.16; p=0.60), with a higher bleeding risk seen in the aspirin group. Kaplan-Meier curves showed no significant difference in composite events with (p=0.61) or without major bleeding (p=0.21).

The following factors were found to be predictive of composite events and bleeding: age, chronic kidney disease, and low levels of high-density lipoprotein cholesterol.

“The widespread use of coronary computed tomographic angiography has increased the number of cases of coronary stenosis in asymptomatic individuals,” the authors said.