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Aspirin resistance and adverse clinical events in patients with coronary artery disease.

Chen WH, Cheng X, Lee PY, Ng W, Kwok JY, Tse HF, Lau CP

Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. whchen@hku.hk

PURPOSE: We sought to determine the clinical significance of aspirin resistance measured by a point-of-care assay in stable patients with coronary artery disease (CAD). METHODS: We used the VerifyNow Aspirin (Accumetrics Inc, San Diego, Calif) to determine aspirin responsiveness of 468 stable CAD patients on aspirin 80 to 325 mg daily for > or =4 weeks. Aspirin resistance was defined as an Aspirin Reaction Unit > or =550. The primary outcome was the composite of cardiovascular death, myocardial infarction (MI), unstable angina requiring hospitalization, stroke, and transient ischemic attack. RESULTS: Aspirin resistance was noted in 128 (27.4%) patients. After a mean follow-up of 379+/-200 days, patients with aspirin resistance were at increased risk of the composite outcome compared to patients who were aspirin-sensitive (15.6% vs 5.3%, hazard ratio [HR] 3.12, 95% confidence intervals [CI], 1.65-5.91, P < .001). Cox proportional hazard regression modeling identified aspirin resistance, diabetes, prior MI, and a low hemoglobin to be independently associated with major adverse long-term outcomes (HR for aspirin resistance 2.46, 95% CI, 1.27-4.76, P = .007). CONCLUSIONS: Aspirin resistance, defined by an aggregation-based rapid platelet function assay, is associated with an increased risk of adverse clinical outcomes in stable patients with CAD.

Published 2 July 2007 in Am J Med, 120(7): 631-5.
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