Association of Aspirin Treatment With Cardiac Allograft Vasculopathy Progression and Adverse Outcomes After Heart Transplantation

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...

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Published in:Journal of cardiac failure 2021-05, Vol.27 (5), p.542-551
Main Authors: Asleh, Rabea, Briasoulis, Alexandros, Smith, Byron, Lopez, Camden, Alnsasra, Hilmi, Pereira, Naveen L., Edwards, Brooks S., Clavell, Alfredo L., Stulak, John M., Locker, Chaim, Kremers, Walter K., Daly, Richard C., Lerman, Amir, Kushwaha, Sudhir S.
Format: Article
Language:English
Subjects:
aspirin
Cardiac allograft vasculopathy
coronary intravascular ultrasound
heart transplantation
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Summary: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. 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). 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.
ISSN:1071-9164
1532-8414
DOI:10.1016/j.cardfail.2021.01.019