PURPOSE: Enhanced platelet reactivity may play a role in the development and progression of cardiac allograft vasculopathy (CAV). Although aspirin is often a part of the medication regimen after heart transplantation (HT), limited evidence is available on its effects on CAV and related outcomes. In this large study, we sought to investigate whether aspirin treatment has an independent impact on CAV progression using coronary intravascular ultrasound (IVUS) follow-up studies and clinical outcomes after long-term follow-up post HT. METHODS: CAV progression, all-cause and cardiac mortality were compared between HT patients taking and those not taking aspirin from 1994 to 2016 at a single institution. CAV progression was assessed by measuring the log ratio of the last to first plaque index (PI, ratio of plaque volume to vessel volume) between last follow-up and baseline coronary IVUS after adjustment for age, time to first IVUS, conversion to sirolimus, and time between IVUS studies. Survival analyses were performed using Cox regression models with aspirin treated as a time-dependent predictor conditional on patients being alive at 6 months post HT. RESULTS: Overall, 530 HT recipients (308 patients received sirolimus-based and 222 received calcineurin inhibitor-based immunosuppression) were retrospectively analyzed, among which 323 patients underwent at least 2 IVUS studies post HT. Length of aspirin use was modestly associated with attenuated progression of plaque index ratio (r=-0.14, p=0.02) (Figure 1A). Cox regression with adjustment for clinically relevant characteristics, including conversion to sirolimus, and CAV grade at 1 year post HT did not suggest any difference in all-cause mortality (hazard ratio [HR] 0.9; 95% confidence interval [CI] 0.6 to 1.3, p=0.45) (Figure 1B) or cardiac death (HR 1.5, 95% CI 0.7 to 3.2, p = 0.33) (Figure 1C) after a median follow-up time of 10 years post HT. CONCLUSION: Aspirin use may delay CAV progression but does not affect long-term survival after HT.
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine