Association between prior aspirin use and optical coherence tomography findings in type II diabetes mellitus patients presenting with first acute coronary events

Abstract

Aims: Aspirin has been shown to be beneficial in the primary prevention, secondary prevention, and treatment of acute coronary syndromes (ACS). However, it is less clear whether prior aspirin therapy affects lesion morphology in ACS. The aim of the present study is to investigate the association between prior aspirin use and the culprit lesion morphology examined by optical coherence tomography (OCT) in patients with the first ACS event. We further performed subgroup analysis on the basis of the presence or the absence of type 2 diabetes mellitus (DM). Methods and results: We studied 250 patients with the first ACS event who had identifiable 250 native de novo culprit lesions suitable for percutaneous coronary intervention (PCI) and OCT examinations. All patients underwent OCT examinations before PCI. Clinical and OCT findings were compared between the two groups divided on the basis of prior aspirin use (ASA; n= 27: 11%, non-ASA; n = 223: 89%), and then, in diabetic (n=75, 30%) and non-diabetic patients (n=175, 70%) for the subset analysis. TCFA was defined as lipid-rich plaque (one or more quadrants) with fibrous cap thickness < 70μm. There were no significant differences in the clinical presentations between ASA and non-ASA groups. Frequency of coronary occlusion at initial angiogram was also similar in both groups (ASA: 30% vs non-ASA: 24%, P = 0.64). In DM subgroup analysis, 7 (9%) patients were ASA group and 68 (91%) were non-ASA group, whereas 20 (11%) patients were ASA group and 155 (89%) were non-ASA group in non-DM subgroup. In OCT analysis, the presence of thrombi (ASA: 41% vs. non-ASA: 70%, P < 0.01) was significantly less frequent in ASA group, whereas frequency of TCFA (ASA: 48% vs. non-ASA: 60%, P = 0.30), plaque rupture (ASA: 26% vs. non-ASA: 42%, P = 0.15), thinnest cap thickness (ASA: median: 60 μm [IQR: 50-105] vs. non-ASA: 60 μm [50-80], P = 0.71), and lipid quadrants (ASA: median: 3 [IQR: 2-4] vs. non-ASA: 3 [3-4], P = 0.87) were not statistically significant between the two groups. In non-diabetic patients, presence of thrombi was significantly greater in non-ASA group (ASA: 30% vs. non-ASA: 71%, P <0.01), whereas no significant difference in the frequency of the presence of thrombi was observed in diabetic patients (ASA: 71% vs. non-ASA: 68%, P =1.00). No other differences in OCT findings were detected between diabetic and non-diabetic patients. Conclusions: Prior aspirin use before the first ACS event was associated with the frequency of OCT-derived thrombus detection in the culprit lesions, although this effect was observed only in non-diabetic patients.