Abstract 17057: Long Term Outcomes in Coronary Artery Disease Patients With Acetylsalicylic Acid Sensitivity Undergoing a Novel Desensitization Protocol

Abstract

Purpose: Aspirin therapy is the cornerstone of treatment in patients (pts) with coronary artery disease, particularly those undergoing percutaneous coronary intervention (PCI). The aim of this study was to test the safety and efficacy of a new standard desensitization procedure, using escalating low doses of aspirin in pts with acetylsalicylic acid sensitivity. Methods: Out of 3080 pts undergoing coronary angiography, seventy-seven had a history of aspirin sensitivity (2.5%). A history of cutaneous reactions (urticaria and/or angioedema) was reported in 76% of pts, respiratory sensitivity (asthma and/or rhinitis) in 21.5%, whereas 2.5% had a history of anaphylactic shock. All pts underwent the desensitization procedure: six sequential doses of aspirin (1, 5, 10, 20, 40, and 100 mg) administered orally at predefined intervals, with the procedure lasting 5.5 hours. None received pretreatment with antihistamines or corticosteroids. Blood pressure, pulse, cutaneous, nasoocular, or pulmonary reactions were monitored until 4 hours after the procedure. Pts were followed-up for 18.1± 6.3 months. Major adverse cardiac events (MACE), defined as death, repeat revascularization and stroke were recorded. Results: The desensitization procedure was successful in 71 pts (92.2%). No serious adverse reactions occurred: 3 pts with history of idiopathic urticaria developed cutaneous reaction, 2 pts (with frequent asthma attacks) experienced shortness of breath associated with bronchospasm, and 1 pt had shortness of breath without bronchospasm. All reactions were immediately resolved with corticosteroids and antihistamines. All pts but 15 (19.4%) underwent PCI (1.8 stent/pt, DES 75.5%, multivessel PCI 31.4%) and were discharged on dual antiplatelet therapy. At follow-up, aspirin was maintained in 92.9% pts. None of the discontinuations were due to allergic reaction. The incidence of MACE was 6.5% (1 non-cardiac death and 4 repeat revascularizations). None of the pts experienced stent thrombosis. Conclusions: This novel desensitization procedure seems to be safe and effective. Complex PCI procedures can be performed also in such pts, without increasing the risk of stent thrombosis.