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European Heart Journal Advance Access published online on September 26, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn417
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study

Sanjit S. Jolly1,*, Janice Pogue1, Kimberly Haladyn1, Ron J.G. Peters2, Keith A.A. Fox3, Alvaro Avezum4, Bernard J Gersh5, Hans Jurgen Rupprecht6, Salim Yusuf1 and Shamir R. Mehta1

1 Department of Medicine, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
2 Academic Medical Center, Amsterdam, The Netherlands
3 Department of Cardiology, the University and the Royal Infirmary of Edinburgh, Edinburgh, UK
4 Dante Pazzanese Institute of Cardiology, Sao Paolo, Brazil
5 Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
6 GPR Clinikum Russelsheim, Russelsheim, Germany

Received 25 February 2008; revised 22 August 2008; accepted 28 August 2008.

* Corresponding author: McMaster University and Population Health Research Institute, Hamilton Health Sciences, McMaster Clinic Room 630, 237 Barton St. East, Hamilton, ON, Canada L8L 2X2. Tel: +1 905 524 2712, Fax: +1 905 523 8352, Email: jollyss{at}mcmaster.ca

Aims: In the setting of percutaneous coronary intervention (PCI), due to a paucity of data, the optimal dose of aspirin is uncertain. We evaluated the safety of different doses of aspirin after PCI.

Methods and results: In the PCI-CURE study, 2658 patients with acute coronary syndromes undergoing PCI were stratified into three aspirin dose groups ≥200 mg (high, n = 1064), 101–199 mg (moderate, n = 538), and ≤100 mg (low, n = 1056). For efficacy, the moderate- (7.4%) and high-dose groups (8.6%) had similar rates of cardiovascular death, myocardial infarction, or stroke compared with the low-dose group (7.1%). For safety, major bleeding was increased with high-dose aspirin [3.9, 1.5, and 1.9% in the high-, moderate-, and low-dose groups; hazard ratio (HR) of high vs. low dose 2.05 (95% CI 1.20–3.50, P = 0.009]. The net adverse clinical events (death, MI, stroke, major bleeding) favoured low-over high-dose aspirin (8.4 vs. 11.0%, HR 1.31, 95% CI 1.00–1.73 P = 0.056).

Conclusion: In this large observational analysis of patients undergoing PCI, low-dose aspirin appeared to be as effective as higher doses in preventing ischaemic events but was also associated with a lower rate of major bleeding and an improved net efficacy to safety balance.

Key Words: Aspirin • Percutaneous coronary transluminal angioplasty • Myocardial infarction • Haemorrhage


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