65 year old male with known extensive CAD and prior PCI’s in 2008, presented with NSTEMI (TnI 0.54). A Cardiac Cath on August 6, 2018 revealed 3 V CAD: Subtotal prox RCA and 90% mid RCA DES ISR, 70% proximal LAD DES ISR, 95% multiple calcified proximal LCx lesions, and subtotal small LCx-LPL1 with SYNTAX Score of 25 and LVEF of 60%. Patient underwent successful intervention of culprit proximal and mid RCA using rotational atherectomy and two Promus Premier DES. Subsequently patient had stress MPI revealing moderate to severe lateral and interolateral ischemia and mild anterior ischemia. Patient is now planned for staged PCI of proximal LCx and proximal LAD with dedicated 2 stent technique and OCT imaging guidance.
Moderator: Sameer Mehta, MD
All 3 publications showing no overall benefit of aspirin despite slight decrease in cV events in various primary prevention settings are important as they also showed slight increase in GI hemorrhage and cancer. Hence be away from aspirin unless you had CAD symptoms or ACS.
The aspirin message is clear that aspirin should not be routinely prescribed for primary prevention even in diabetics.
The reasons for higher cancer in aspirin group is not clear and is being intensely studied currently.
Yes, I am asking pts not to take aspirin for the indication of primary prevention.
Yes. No need to take aspirin unless you have ACS or CAD or had a procedure.
Aspirin is indicated in ACS & CAD pts, post PCI pts and post CABG pts.
Aspirin 75-100mg daily. In pts weighing >80kg, I will recommend 162mg daily.
Aspirin is not recommended in the primary prevention and diabetic setting.
Only future trials will show the final role of aspirin in the CAD pts and may very well be eliminated from the therapeutic armamentarium.
Yes, upcoming guideline will incorporate these updated recommendations.
71 year old male with multiple CAD risk factors presented with NSTEMI, pneumonia and septic shock in October 2018.
57 year old diabetic male presented with new onset CCS Class II angina and positive stress echo for multisegmental wall hypokinesis.
86 year old female with chronic stable angina CCS Class II and positive MPI for two years being managed on medication.
62 year old male presented with CCS Class II angina and positive SPECT MPI for basal inferior and inferolateral moderate size area of ischemia and infarction.