Pre-existing treatment with aspirin or statins influences clinical presentation, infarct size and inflammation in patients with de novo acute coronary syndromes

Int J Cardiol. 2019 Jan 15;275:171-178. doi: 10.1016/j.ijcard.2018.10.050. Epub 2018 Oct 16.

Abstract

Background: Influence of pre-existing treatment with aspirin and/or statins prior to a first acute coronary syndrome (ACS) on clinical presentation, infarct size and inflammation markers. We analyzed patients from the Swiss Program University Medicine ACS-cohort (SPUM-ACS; ClinicalTrials.govnumber:NCT01075867).

Methods: 1639 patients were categorized into 4 groups: (1) patients without either drug (n = 1181); (2) patients only on aspirin (n = 157); (3) patients only on statins (n = 133) and (4) patients on both drugs (n = 168). Clinical features, electrocardiogram (ECG), creatinine kinase (CK, U/l), high-sensitivity troponin T (hsTNT, μg/l), N-terminal brain natriuretic peptide (NT-proBNP, ng/l), leucocytes (Lc, G/l), neutrophils (Nc, G/l), C-reactive protein (CRP, mg/l) and angiographic features were documented at baseline.

Results: Incidences of ST-elevation myocardial infarction (STEMI) were 64% in group 1, 45% in group 2, 52% in group 3 and 40% in group 4 (p < 0.0001). Those with both drugs had significantly lower CK (median 145 U/l, interquartile range (IQR) 89-297), hsTNT (median 0.13 μg/l, IQR 0.03-0.52) and higher left ventricular ejection fraction values (LVEF) (mean 55 ± 12%) compared to untreated patients (median CK 273 U/l, IQR 128-638; median hsTNT 0.26 μg/l, IQR 0.08-0.85; mean LVEF 51 ± 11%) (p < 0.0001, p = 0.001, p = 0.028, respectively). Co-medicated groups matched for high risk factors presented less frequently as STEMIs (p < 0.0001), had significantly smaller infarcts determined by CK and hsTNT (both p < 0.0001) and lower CRP levels (p = 0.01) compared to patients without pre-existing treatment with either drug.

Conclusion: Pre-existing treatment with aspirin and/or statins and particularly with their combination changes the clinical presentation, infarct size, inflammation markers and LVEF in patients suffering their first ACS.

Keywords: ACS; Aspirin; Biomarkers; ECG; Inflammation; Statins.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Coronary Syndrome / complications*
  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / drug therapy
  • Aged
  • Aspirin / therapeutic use*
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • Coronary Angiography
  • Electrocardiography*
  • Female
  • Follow-Up Studies
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Inflammation / diagnosis
  • Inflammation / drug therapy*
  • Inflammation / etiology
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / drug therapy*
  • Myocardial Infarction / etiology
  • Natriuretic Peptide, Brain
  • Peptide Fragments
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prognosis
  • Prospective Studies
  • Stroke Volume / physiology
  • Troponin T / blood
  • Ventricular Function, Left / physiology

Substances

  • Biomarkers
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Peptide Fragments
  • Platelet Aggregation Inhibitors
  • Troponin T
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • C-Reactive Protein
  • Aspirin

Associated data

  • ClinicalTrials.gov/NCT01075867