Influence of previous long-term treatment with aspirin on clinical progression of an acute coronary syndrome


Authors: J. Špác 1;  J. Pařenica 2
Authors‘ workplace: II. interní klinika Lékařské fakulty MU a FN u sv. Anny, Brno, přednosta doc. MUDr. Miroslav Souček, CSc. 1;  Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Špinar, CSc., FESC 2
Published in: Vnitř Lék 2005; 51(6): 664-670
Category: Original Contributions

Overview

There is a failure of antiaggregation treatment in a large group of patients with chronic forms of ischaemic disease leading to recurrence of ischaemic events. The objective of this paper is to analyse the influence of previous long-term antiaggregation treatment on clinical progression of an acute coronary syndrome.

Method:
The importance of previous treatment has been evaluated in 726 patients admitted into 38 hospitals in Czech Republic for acute coronary syndrome (ACS) without ST segment elevations inthe year 2000. 396 patients were treated with aspirin (group A) on a long-term basis before admission and 330 patients were without aspirin treatment before the admission into hospital (group B).

Results:
Patients in group A showed less frequently signs of myocardial infarction (MI) without ST segment elevations (21.8% versus 26.9%, NS) on admission and a progression of acute coronary syndrome into Q wave MI was less frequent in this group (5% versus 10.6%, p < 0.005) compared to patients in group B. However patients in group A had more frequently the incidence of recurrent angina pain (24.8% versus 13.9%, p < 0.005) and intervention methods of treatment were used more frequently in this group due to failure of a response to conservative treatment (coronarography – 30% versus 22.7%, p < 0.05, PTCA - 10% versus 8.2%, NS, and CABG – 10.2% and 4.2%, p < 0.005 versus group B). There were no differences in using of other methods of pharmacological medication between groups. The analysis demonstrated that even previous history of ACS does not influence the results.

Conclusion:
Patients with long-term antiaggregation treatment exhibit manifestations of less severe forms of acute coronary syndrome during the development of ACS but they respond worse to the conservative treatment in furtherprogression of the disease and they need to be treated with intervention methods more frequently. The mechanism responsible for these facts is thought to be an occurrence of inadequate response to the aspirin treatment. One of the approaches to improve this situation is using of quantitatively evaluated targeted antiaggregation treatment tailored to individual patients.

Key words:
acute coronary syndrome – aspirin treatment


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Labels
Diabetology Endocrinology Internal medicine

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